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a College of Nursing and Health Professions, University of North Carolina at Charlotte
b Donald W. Reynolds Department of Geriatrics, University of Oklahoma College of Medicine, Oklahoma City
c Clinical Services, Hospice at Charlotte, NC
d College of Nursing, University of Oklahoma Health Sciences Center, Oklahoma City
e Long-Term Care Administration, Oklahoma City, OK
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 28223-0001. E-mail: sstravis{at}email.uncc.edu.
Decision Editor: Laurence G. Branch, PhD
Purpose: This exploratory study used a set of four obstacle constructs derived from both the existing literature and our earlier work to describe the diverse end-of-life scenarios observed for a group of residents in a long-term care facility. Design and Methods: Data from a retrospective chart review and both quantitative and qualitative methods of data collection and analysis were used to examine in-depth the end-of-life experiences of all nursing home residents (N = 41) who died on the nursing care unit of a large continuing care retirement community during an 18-month period. Results: A hierarchy of obstacles to palliation and end-of-life care seems to exist in long-term care settings that begins with the lack of recognition that restorative, rehabilitative, or curative treatment futility has commenced. The next three obstacles in sequence include lack of communication among decision makers, no agreement on a course of care, and failure to implement a timely plan of care. Implications: The findings highlight the importance of determining treatment futility as an initial step in the successful delivery of palliative and end-of-life care to residents in long-term care followed by the need for a deliberate and proactive series of actions and care planning processes.
Key Words: Terminal decline • Advance directives • Late life long-term care
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