Palliative care, which focuses on alleviating symptoms and reducing the stress of serious illnesses, remains significantly underutilised in nursing homes despite the high prevalence of conditions such as cancer, dementia, Parkinson’s disease, heart failure, and chronic obstructive pulmonary disease among residents. A qualitative study published in the Journal of the American Geriatrics Society explores the inadequate use of palliative care referrals in these settings and offers strategies to address this gap. The research reviews existing referral patterns and proposes a robust framework to enhance palliative care referrals in nursing homes.
It is crucial to note that palliative care is broader than hospice care and can be provided to individuals at any stage of a severe illness, often in conjunction with other treatments. The extent of palliative care required can vary depending on the individual needs of nursing home residents. Some may need just a single consultation to adjust medications and develop a care plan, while others with persistent symptoms or frequent changes in their condition may require ongoing support.
Kathleen Unroe, M.D., MHA, co-author of the study and a research scientist at the Regenstrief Institute, emphasised the importance of palliative care in these facilities. She noted that while palliative care is essential for residents with advanced diseases, especially those with advanced dementia, it is not uniformly available across all U.S. nursing homes. The availability of non-hospice palliative care is particularly scarce, often depending on geographic location.
Dr. Unroe, an associate professor of medicine at the Indiana University School of Medicine – Indianapolis, pointed out that primary care providers in nursing homes are capable of delivering substantial supportive care. However, there are instances where the expertise of palliative care consultants is crucial for providing specialised care. Despite the clear need, the implementation of palliative care services is fraught with challenges, though it is successfully being integrated in some facilities and regions. The study aims to gather insights from professionals in the field to develop best practice models and establish standard care protocols.
The researchers stress the need for nursing home staff to be aware of and trained in palliative care to identify residents needing such services effectively. They propose exploring five key areas to pinpoint residents with unmet palliative care needs. Dr Unroe highlighted the need for innovative solutions to provide palliative care training to frontline staff and primary care providers, thus ensuring that residents’ complex care needs are met. Furthermore, systematic processes must be established to identify those requiring a higher level of specialised palliative care.
The team continues to evaluate current practices and develop new evidence-based tools and models to enhance and standardise palliative care in nursing homes. Creating scalable models that can be broadly implemented aims to ensure all nursing home residents have equitable access to palliative care. Connie S. Cole, PhD, DNP, from the University of Colorado and the study’s lead author, emphasised the importance of implementing standardised referral criteria to facilitate equitable access to palliative care. She also stressed the value of educating residents and their families about palliative care, enabling them to make informed decisions about their care preferences.
More information: Connie S. Cole et al, Palliative care in nursing homes: A qualitative study on referral criteria and implications for research and practice, Journal of the American Geriatrics Society. DOI: 10.1111/jgs.18938
Journal information: Journal of the American Geriatrics Society Provided by Regenstrief Institute
