What Models Exist for Delivering Palliative Care and Hospice in Nursing Homes?

Evidence shows that residents of nursing homes have underrecognized and unmet palliative care needs. Although there are challenges to delivering palliative care in nursing homes, several distinct advantages to opportunities for promoting palliative care practices in these facilities exist as well. Nursing homes are more homelike than many other settings, and residents and families often form meaningful relationships with the nursing home staff over time. Furthermore, as efforts to implement culture change programs and enhance person-centered care grow, there is an expanded focus on considering resident and family needs and preferences, making the setting ripe for discussions regarding end-of-life preferences and advance care planning. Residents and families should understand their end-of-life options and have an opportunity to clarify their preferences. At the end of life, residents’ symptoms, particularly pain, must be managed. With increased education, nursing home staff will be better able to incorporate palliative care into their practices. With increased awareness among regulators and payers, external challenges to palliative care can be mitigated. This includes better integration of hospice into the nursing home setting. For the frail and elderly residents who die each year in nursing homes and their families, palliative care can make their experiences less physically and emotionally painful. To deliver this needed care and meet the needs of millions of residents and families, nursing homes must capitalize on their strengths and find ways to overcome their weaknesses. Palliative care providers must continue to reach out to nursing homes, work side by side with nursing home providers and hospice agencies, and develop strategies to support these high-need residents.