| Description |
Clinical practice guidelines and accrediting agencies emphasize the need for palliative care in nursing homes and care coordination between the hospital and nursing home. However, it is unclear how care is managed for patients discharged to nursing homes after a hospital-based palliative care consult. The purpose of this study was to describe the continuity of care, experiences, and outcomes of residents in a nursing home after palliative care consult during hospitalization. A qualitative descriptive approach was used to enroll a sample of 12 adults, 60 years or older, with a life expectancy of at least 7 days, who received a palliative care consult during hospitalization, and who were discharged to a nursing home without hospice support. Participants' charts were reviewed for clinical information at five time points from hospital discharge to 100 days after nursing home admission. Face-to-face semistructured interviews were conducted, individual chart data were extracted, and care trajectories were mapped. Audio recordings of the interviews were transcribed, and transcripts were imported into a qualitative data analysis software program that was used to organize and manage all data. Content analysis was employed to identify codes, categories, and themes. The mean age of this sample was 80 years (range 62-95). All participants were seriously ill and received goals-of-care conversations facilitated by a palliative care team in the hospital; care preferences ranged from comfort care only to aggressive life-prolonging treatments. However, all participants accessed the Medicare skilled nursing facility benefit upon nursing home iv admission, which indicated a need for rehabilitative or restorative care. None of the participants accessed hospice services in the nursing home. Study findings indicate that despite receiving a palliative care consultation, continuity in care was largely insufficient, and palliative care follow-up was episodic. Three influences on care discontinuity for this complex group of patients are care-setting transitions, individual patient- and family-level factors, and system-level interference. To improve palliative care throughout illness trajectory, older adults need better access to ongoing community and primary palliative care. |
