End-of-Life Culture Change Practices in U.S. Nursing Homes in 2016/2017
Department of Population and Quantitative Health Sciences
Geriatrics | Health Psychology | Health Services Administration | Health Services Research | Palliative Care
CONTEXT: The nursing home (NH) culture change (CC) movement, which emphasizes person-centered care, is particularly relevant to meeting the unique needs of residents near the end of life.
OBJECTIVES: We aimed to evaluate the NH-reported adoption of person-centered end-of-life culture change (EOL-CC) practices and identify NH characteristics associated with greater adoption.
METHODS: We used NH and state policy data for 1358 NHs completing a nationally representative 2016/17 NH Culture Change Survey. An 18-point EOL-CC score was created by summarizing responses from six survey items related to practices for residents who were dying/had died. NHs were divided into quartiles reflecting their EOL-CC score, and multivariable ordered logistic regression was used to identify NH characteristics associated with having higher (quartile) scores.
RESULTS: The mean EOL-CC score was 13.7 (SD = 3.0). Correlates of higher scores differed from those previously found for non-EOL-CC practices. Higher NH leadership scores and nonprofit status were consistently associated with higher EOL-CC scores. For example, a three-point leadership score increase was associated with higher odds of an NH performing in the top EOL-CC quartile (odds ratio [OR] = 2.0, 95% CI: 1.82-2.30), whereas for-profit status was associated with lower odds (OR = 0.7, 95% CI: 0.49-0.90). The availability of palliative care consults was associated with a greater likelihood of EOL-CC scores above the median (OR = 1.5, 95% CI: 1.10-1.93), but not in the top or bottom quartile.
CONCLUSION: NH-reported adoption of EOL-CC practices varies, and the presence of palliative care consults in NHs explains only some of this variation. Findings support the importance of evaluating EOL-CC practices separately from other culture change practices.
Nursing homes, culture change, end-of-life, palliative care, person-centered care
DOI of Published Version
J Pain Symptom Manage. 2019 Mar;57(3):525-534. doi: 10.1016/j.jpainsymman.2018.12.330. Epub 2018 Dec 20. Link to article on publisher's site
Journal of pain and symptom management
Schwartz ML, Lima JC, Clark MA, Miller SC. (2019). End-of-Life Culture Change Practices in U.S. Nursing Homes in 2016/2017. Population and Quantitative Health Sciences Publications. https://doi.org/10.1016/j.jpainsymman.2018.12.330. Retrieved from https://escholarship.umassmed.edu/qhs_pp/1238