Quality End-of-Life Care in Nursing Homes

The Impact of Quality End-of-Life Care in Nursing Homes

The purpose of this study is to examine key organizational structures and processes (leadership, teamwork, communication, palliative care) and their impact on the quality of end-of-life care for dying residents and their family members.

Study Overview

• Status: Completed
• Conditions: Quality of End-of-life Care in Nursing Homes

Detailed Description

As the American population ages, nursing homes are rapidly becoming a dominant site for death. Currently, 25% of all deaths occur in nursing homes and 35% of all elders over the age of 85 die in nursing homes. By 2020, 40% of those over 65 will die in nursing homes. Nursing home residents die in pain with undue psychosocial suffering. For all permanently placed residents, death is inevitable. Nonetheless, how residents die, is not.

There have been long standing concerns about the quality of care and quality of life in nursing homes. Although there is some evidence that the quality of care for nursing home residents has improved, serious problems continue in areas that potentially affect end-of-life such as dehydration, pressure ulcers, and pain. Efforts to improve care have rarely considered the dynamic nature of nursing home structure and process factors, such as staffing levels, leadership of the director of nursing, or communication and teamwork among staff that facilitate or impede the organization's ability to improve care processes. Findings from our preliminary studies in nursing homes indicate that organizational structure and process factors make a difference in end-of-life care for residents and their family members. More specifically, staff education, staffing levels, leadership of the Director of Nursing (DON) and administrator, teamwork and communication among direct care staff, and incorporating palliative care clinical practices into day-to-day care had a profound impact on outcomes such as the honoring of end-of-life preferences, symptom management, and satisfaction with care. A more generalizable understanding of key structure and process factors and their relationship to resident care and outcomes at the end-of-life will provide a foundation for future intervention studies aimed at improving care.

• Study Type: Observational
• Enrollment (Actual): 7169

Contacts and Locations

Study Locations

• United States
  • Nebraska
    • Omaha, Nebraska, United States, 68198
      • University of Nebraska Medical Center

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 19 years and older (Adult, Older Adult)
• Accepts Healthy Volunteers: No

• Sampling Method: Non-Probability Sample

Study Population

Nursing Homes in Nebraska and the Western half of Iowa, nursing home staff, and family members/significant other of nursing home residents

Description

Inclusion Criteria (Nursing Homes):

• 60 beds or greater

Exclusion Criteria (Nursing Homes):

• less than 60 beds

Inclusion Criteria (Nursing Home Staff):

• 19 years of age or older
• trained to provide resident care

Exclusion Criteria (Nursing Homes):

• less than 19 years of age
• staff on units exclusively Medicare or average length of stay less than 30 days

Inclusion Criteria (Family Member/Significant Other):

• 19 years of age or older
• somewhat to very involved in resident's care and decision-making

Exclusion Criteria (Family Member/Significant Other):

• not involved in resident's care and decision-making
• resident was in the nursing home less than 31 days
• resident was less than 65 years old

Study Plan

How is the study designed?

Number of groups / cohorts

2

Cohorts and Interventions

Group / Cohort
1 Nursing Home Staff; Direct care staff
2 Family Members; Family members/Significant other of nursing home resident.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Palliative care influence	Questionnaires (nursing home staff and family members) to assess the influence of palliative care on staff performance (communication, leadership, and teamwork).	At beginning of study (baseline), then again after 25 nursing home residents have died (assessed for 7 years)

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Staffing and quality of end-of-life care	Questionnaires (nursing home staff and family members) to assess the associations among structure (staffing), non-clinical (communication, leadership, teamwork) and clinical (palliative care) care processes and quality of end-of-life care.	At beginning of study (baseline), then again after 25 nursing home residents have died (assessed for 7 years)
Modelling nursing home palliative care	Questionnaires (nursing home staff and family members) to assess modelling of nursing home palliative care (Unruh and Wan's expanded structure, process, and outcomes model).	At beginning of study (baseline), then again after 25 nursing home residents have died (assessed for 7 years)

Collaborators and Investigators

• Sponsor: University of Nebraska
• Collaborators: National Institute of Nursing Research (NINR); National Institutes of Health (NIH)
• Investigators: Principal Investigator: Sarah A Thompson, RN, PhD, University of Nebraska; Principal Investigator: Virginia Tilden, RN, DNSC, University of Nebraska

Publications and helpful links

Helpful Links

• University of Nebraska Medical Center

Study record dates

Study Major Dates

• Study Start (Actual): December 15, 2006
• Primary Completion (Actual): January 1, 2011
• Study Completion (Actual): January 1, 2011

Study Registration Dates

• First Submitted: February 4, 2008
• First Submitted That Met QC Criteria: February 4, 2008
• First Posted (Estimated): February 15, 2008

Study Record Updates

• Last Update Posted (Estimated): December 4, 2023
• Last Update Submitted That Met QC Criteria: November 29, 2023
• Last Verified: November 1, 2023

More Information

Terms related to this study

• Additional Relevant MeSH Terms: Pathologic Processes; Death
• Other Study ID Numbers: 0433-06-FB; 7R01NR009547-02 (U.S. NIH Grant/Contract)