Nursing homes are the site of death for many elderly patients with incurable
chronic illness, yet dying nursing home residents have limited access to palliative
care and hospice. The probability that a nursing home will be the site of
death increased from 18.7% in 1986 to 20.0% by 1993. Dying residents experience
high rates of untreated pain and other symptoms. They and their family members
are isolated from social and spiritual support. Hospice improves end-of-life
care for dying nursing home residents by improving pain control, reducing
hospitalization, and reducing use of tube feeding, but it is rarely used.
For example, in 1997 only 13% of hospice enrollees were in nursing homes while
87% were in private homes, and 70% of nursing homes had no hospice patients.
Hospice use varies by region, and rates of use are associated with nursing
home administrators' attitudes toward hospice and contractual obligations.
Current health policy discourages use of palliative care and hospice for dying
nursing home residents. Quality standards and reimbursement rules provide
incentives for restorative care and technologically intensive treatments rather
than labor-intensive palliative care. Reimbursement incentives, contractual
requirements, and concerns about health care fraud also limit its use. Changes
in health policy, quality standards, and reimbursement incentives are essential
to improve access to palliative care and hospice for dying nursing home residents.
Register and get free email Table of Contents alerts, saved searches, PowerPoint downloads, CME quizzes, and more
Subscribe for full-text access to content from 1998 forward and a host of useful features
Activate your current subscription (AMA members and current subscribers)
Purchase Online Access to this article for 24 hours
Some tools below are only available to our subscribers or users with an online account.
Download citation file:
Web of Science® Times Cited: 87
Customize your page view by dragging & repositioning the boxes below.
More Listings atJAMACareerCenter.com >
and access these and other features:
Enter your username and email address. We'll send you a link to reset your password.
Enter your username and email address. We'll send instructions on how to reset your password to the email address we have on record.
Athens and Shibboleth are access management services that provide single sign-on to protected resources. They replace the multiple user names and passwords necessary to access subscription-based content with a single user name and password that can be entered once per session. It operates independently of a user's location or IP address. If your institution uses Athens or Shibboleth authentication, please contact your site administrator to receive your user name and password.