Adir Shaulov1, Meir Frankel2, Alan Rubinow3, Yoram Maaravi4, Mayer Brezis2. 1. Department of Internal Medicine, Hadassah-Hebrew University Medical Center, Mount Scopus, Jerusalem, Israel. 2. Center for Clinical Quality and Safety, Hadassah-Hebrew University Medical Center, Ein Kerem, Jerusalem, Israel. 3. Ministry of Health, Jerusalem, Israel. 4. Department of Geriatric Medicine, Hadassah-Hebrew University Medical Center, Mount Scopus, Jerusalem, Israel.
Abstract
OBJECTIVES: To evaluate the quality of end-of-life (EOL) care in nursing homes. DESIGN: Survey and semistructured interviews. SETTING: Jerusalem district nursing homes. PARTICIPANTS: Staff members of 28 long-term care and skilled nursing facilities in the Jerusalem area in Israel of various ethnic, religious, and administrative affiliations (N = 207). MEASUREMENTS: Qualitative analysis of semistructured interviews and statistical analysis of questionnaires. RESULTS: Most staff members reported that EOL preferences were unknown for more than 90% of residents and that fewer than 10% had a healthcare proxy. Most staff members recalled conducting fewer than five EOL conversations over the past year with residents or family members and could recall fewer than five cases in which a resident was allowed to die in the nursing home. According to staff opinions the prevalence of tube feeding was estimated at greater than 10%, initiated because of aspiration, malnutrition, and understaffing, often against family's preferences. More than 25% of staff members believed that pain management was inadequate. Knowledge about management of chronic pain was poor in half of nurses and nearly one-third of physicians. Most staff would rather not receive the treatments they administered to residents. CONCLUSION: Nursing homes in Jerusalem lack competency for quality EOL care, and there are multiple psychological, training, and policy challenges to improvement.
OBJECTIVES: To evaluate the quality of end-of-life (EOL) care in nursing homes. DESIGN: Survey and semistructured interviews. SETTING: Jerusalem district nursing homes. PARTICIPANTS: Staff members of 28 long-term care and skilled nursing facilities in the Jerusalem area in Israel of various ethnic, religious, and administrative affiliations (N = 207). MEASUREMENTS: Qualitative analysis of semistructured interviews and statistical analysis of questionnaires. RESULTS: Most staff members reported that EOL preferences were unknown for more than 90% of residents and that fewer than 10% had a healthcare proxy. Most staff members recalled conducting fewer than five EOL conversations over the past year with residents or family members and could recall fewer than five cases in which a resident was allowed to die in the nursing home. According to staff opinions the prevalence of tube feeding was estimated at greater than 10%, initiated because of aspiration, malnutrition, and understaffing, often against family's preferences. More than 25% of staff members believed that pain management was inadequate. Knowledge about management of chronic pain was poor in half of nurses and nearly one-third of physicians. Most staff would rather not receive the treatments they administered to residents. CONCLUSION: Nursing homes in Jerusalem lack competency for quality EOL care, and there are multiple psychological, training, and policy challenges to improvement.
Authors: Mayer Brezis; Yael Lahat; Meir Frankel; Alan Rubinov; Davina Bohm; Matan J Cohen; Meni Koslowsky; Orit Shalomson; Charles L Sprung; Henia Perry-Mezare; Rina Yahalom; Amitai Ziv Journal: Isr J Health Policy Res Date: 2017-11-06