Barriers, challenges, and opportunities related to the provision of hospice care in assisted-living communities.

The purpose of this project was to clarify the barriers, challenges, and opportunities associated with providing care to older adults residing in assisted-living communities. Three focus groups (hospice team members, family members of individuals who received hospice care while in assisted living, and administrators of assisted-living communities) were convened to discuss hospice care. Thematic analysis of the transcribed focus group tapes was used by the authors to identify the common and unique barriers, challenges, and opportunities identified by each group. All three groups were overwhelmingly in support of the right of residents in assisted-living communities to live and die in place, without being transferred to nursing homes or other acute-care facilities, and of the role that hospice plays in enabling residents to achieve that goal. The three groups also agreed that trends in the development of assisted-living communities create difficulties for the industry, confusion for consumers, and the need for increased accountability by providers. Delivering hospice care to places where consumers want to live and die in place will be a complex task. Among other things, traditional hospice care is not easily transported into the social models of care characterized by assisted-living environments. Changes in hospice organization policies and procedures will be necessary, as will broader, industry-wide reforms in areas such as recruitment, retention of qualified staff and consistent quality-of-care standards.