Most Nursing Home Residents Eligible for Palliative Care

UCSF Researchers Find Little Access to Necessary Support

Nearly 70 percent of nursing home residents are eligible for palliative care, but do not receive any corresponding support to provide relief from their symptoms and improve their quality of life, according to a study by researchers at UC San Francisco.

In a survey of 228 residents of 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 a hospital readmission in the past year. None were receiving palliative care, and only two were receiving hospice care.

“To our knowledge, this is the first prospective evaluation of nursing home residents’ palliative care needs,” said lead author Caroline Stephens, PhD, RN, GNP-BC, associate professor in the UCSF School of Nursing. “We found a high symptom burden among nursing home residents, with no residents routinely receiving specialty palliative care services in their facilities.”

In the research letter, which appears online Nov. 20, 2017, in JAMA Internal Medicine, the researchers write that earlier identification of palliative care-eligible nursing home residents is crucial. Novel strategies such as telemedicine also are needed, they say, to facilitate access to palliative care services in nursing homes, due to the low supply of palliative care professionals available to care for residents.

By 2030, 40 percent of all U.S. deaths are projected to occur in nursing homes. Despite an estimated $136 billion spent each year on nursing home care, it remains associated with poor symptom control, low family satisfaction, and burdensome and unnecessary care transitions in the final months of life.

In the JAMA Internal Medicine study, researchers found that almost all of the 157 residents (98.7 percent) had a Physician Order for Life-Sustaining Treatment (POLST), with 47.7 percent preferring full treatment, 27.5 percent requesting selective or limited treatment, and 24.8 percent preferring comfort-focused treatment. A POLST is 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.

A sub-study of 17 palliative care-eligible nursing home residents found nearly 53 percent rated their overall quality of life as fair to very poor. This group also reported a higher symptom burden than that perceived by their families.

Other UCSF contributors to the JAMA Internal Medicine study were senior author Sei Lee, MD, MAS, associate professor of geriatrics; Lauren Hunt, MSN, FNP, RN, doctoral candidate; Elizabeth Halifax, PhD, RN, graduate and former research specialist; and Christine Ritchie, MD, MSPH, Harris Fishbon Distinguished Professor in Clinical Translational Research and Aging. Nhat Bui, MSN, AGNP, RN, of Asian Health Services in Oakland and a UCSF graduate, also contributed. Lee and Hunt are with the affiliated San Francisco VA Health Care System. Funding was provided by National Institutes of Health grant 8 KL2 TR000143-08, UCSF Claude D. Pepper Older Americans Independence Center and Tideswell at UCSF.

UC San Francisco (UCSF) is a leading university dedicated to promoting health worldwide through advanced biomedical research, graduate-level education in the life sciences and health professions, and excellence in patient care. It includes top-ranked graduate schools of dentistry, medicine, nursing and pharmacy; a graduate division with nationally renowned programs in basic, biomedical, translational and population sciences; and a preeminent biomedical research enterprise. It also includes UCSF Health, which comprises three top-ranked hospitals, UCSF Medical Center and UCSF Benioff Children’s Hospitals in San Francisco and Oakland, and other partner and affiliated hospitals and healthcare providers throughout the Bay Area.