Nursing homes and assisted living facilities as places for dying.

This chapter reviews the state of knowledge about nursing homes and assisted living facilities as places for dying. Reviewed are 25 published and unpublished research reports by nurse researchers and researchers from other disciplines that address the following questions: (a) What is known about how communication and shared decision-making about end-of-life care preferences occur? (b) How are symptoms assessed and managed at end-of-life? and (c) What are facility characteristics that influence end-of-life care services delivery? Reports were identified through searches of the following databases: MEDLINE, CINAHL, Health Star, PsychLit, Ageline, Ebsco, and PubMed. The following terms guided the search: advance directives, geriatric assessment or nursing, health services for the aged, hospice, residential facilities, palliative care, symptom management, and terminal care. Reports were included if published between 1990 and 2000, if relevant to nursing research on end-of-life care, if conducted on samples age 65 or older and living in nursing home or residential care settings, and if published in English. The studies reviewed were primarily descriptive. The findings indicate that little is known about end-of-life care in these settings, and that family and staff perspectives differ on the nature and quality of the services provided. Both external and internal factors influence the ability of facilities to provide end-of-life care. Recommendations are provided for further research related to nursing homes and assisted living facilities as places for dying.