Nursing home care trajectories for older adults following in-hospital palliative care consultation

Joan G. Carpenter, Patricia H. Berry, Mary Ersek

    Research output: Contribution to journalArticle

    7 Scopus citations

    Abstract

    Palliative care consultation (PCC) during hospitalization is increasingly common for older adults with life-limiting illness discharged to nursing homes. The objective of this qualitative descriptive study was to describe the care trajectories and experiences of older adults admitted to a nursing home following a PCC during hospitalization. Twelve English-speaking adults, mean age 80 years, who received a hospital PCC and discharge to a nursing home without hospice. Data were collected from medical records at five time points from hospital discharge to 100 days after nursing home admission and care trajectories were mapped. Interviews (n = 15) with participants and surrogates were combined with each participant's medical record data. Content analysis was employed on the combined dataset. All PCC referrals were for goals of care conversations during which the PCC team discussed poor prognosis. All participants were admitted to a nursing home under the Medicare skilled nursing facility benefit. Seven were rehospitalized; six of the 12 died within 6 weeks of initial nursing home admission. The two care trajectories were Focus on Rehabilitative Care and Comfort Care Continuity. There was a heavy emphasis on recovering functional status through rehabilitation and skilled nursing care, despite considerable symptom burden and poor prognosis. Regardless of PCC with recommendations for palliative interventions, frail older adults with limited life expectancy and their family caregivers often perceive that rehabilitation will improve physical function. This perception may contribute to inappropriate, ineffective care. More emphasis is needed to coordinate care between PCC recommendations and post-acute care.

    Original languageEnglish (US)
    Pages (from-to)531-536
    Number of pages6
    JournalGeriatric Nursing
    Volume38
    Issue number6
    DOIs
    StatePublished - Nov 2017

    Keywords

    • Hospitalization
    • Nursing homes
    • Palliative care
    • Patient care planning
    • Patient discharge
    • Skilled nursing facilities

    ASJC Scopus subject areas

    • Gerontology

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