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Hospitalization Patterns and Palliation in the Last Year of Life Among Residents in Long-Term Care

^a College of Nursing and Health Professions, University of North Carolina at Charlotte
^b University of Oklahoma College of Nursing, Oklahoma City
^c Susanna Wesley Center at Epworth Villa Lifecare Community, Oklahoma City, OK
^d Donald W. Reynolds Department of Geriatrics, University of Oklahoma College of Medicine, Oklahoma City

Correspondence: Shirley S. Travis, PhD, RN, CS, College of Nursing and Health Professions, University of North Carolina at Charlotte, 9201 University City Boulevard, Charlotte, NC 28223. E-mail: sstravis{at}email.uncc.edu.

Laurence G. Branch, PhD

Purpose: This study compared patterns of care, including hospitalization, during the last year of life for a group of residents in institutional long-term care. These subjects were either implicitly or explicitly in palliative care modes versus those who remained in active treatment or blended care. Design and Methods: The study used a retrospective chart review and both quantitative and qualitative methods of data collection and analysis to examine indepth the end-of-life experiences of 41 nursing home residents who died in the nursing care unit of one large continuing care retirement community during an 18-month period. Results: Most residents die in palliative care modes, but their movement into palliation with comfort care and symptom management is often slowed by indecision or inaction on the part of key decision makers, interrupted by aggressive acute care, or delayed until the last few days of life. Implications: Transitions from active curative care to palliative care are important for residents in permanent long-term care placements. Improved end-of-life care requires more attention to these transitions and to the decisions that residents, their families, and care teams are called upon to make.

Key Words: Advance directives • Caregiver coalitions • End-of-life care