A majority of nursing home residents are eligible for palliative care, but don’t get the kind of support needed to relieve their symptoms and improve their quality of life, according to a UC San Francisco study published online Monday in JAMA Internal Medicine.
In a survey of 228 residents in three northern California nursing homes between January and May 2015, UCSF researchers found that 157 patients (68.8 percent) were eligible for specialized medical care that focuses on improving quality of life for patients with serious illness, known as palliative care. Of those, 47 percent had been diagnosed with Alzheimer’s or dementia, and almost half had be re-admitted to a hospital in the past year.
Yet the report said none of the residents were receiving palliative care, and only two had hospice care.
“To our knowledge, this is the first prospective evaluation of nursing home residents’ palliative care needs,” lead author Caroline Stephens, associate professor in the UCSF School of Nursing said in a statement.
The researchers wrote that it’s important to more quickly identify nursing home residents who would be eligible for palliative care. And with a shortage of palliative care professionals, strategies like telemedicine could be used to improve access to palliative care services in nursing homes, they said.
By 2030, 40 percent of all U.S. deaths are projected to occur in nursing homes, where care costs $136 billion annually. But studies have shown that nursing homes don’t do a good job of keeping patients healthy, have a low family satisfaction, and often lead to burdensome and unnecessary care at the end of life.
Almost all of the 157 residents (98.7 percent) had a Physician Order for Life-Sustaining Treatment (POLST), a legal directive for emergency responders, paramedics and other medical personnel to follow in honoring a patient’s wishes for care when the patient is not legally able to do so.
Of the 157 residents, the report said 47.7 percent indicated they wanted full treatment, 27.5 percent wanted selective or limited treatment, and 24.8 percent preferred comfort-focused treatment at their end of life.
A smaller study of 17 of the palliative care-eligible nursing home residents found nearly 53 percent rated their overall quality of life as fair to very poor.
