Integrating palliative care in the nursing home: an interprofessional opportunity.

More than 25% of Americans now die in a nursing home, with this percentage growing as our country rapidly ages.1,2 By 2030, the nursing home will likely be where 40% or more of Americans will die. Thus, it is imperative that nursing homes prepare for their compelling mission as “palliative care providers.”3 Nursing homes must embrace their role in providing palliative care for their residents with lifelimiting and terminal illness so as to provide those appropriate and limited interventions based on the goals of care. Similarly, nursing homes also must be prepared to provide hospice or full comfort care for those residents who are dying. Although still wholly underused, palliative care programs and hospice services are fortunately being used more frequently in the nursing home setting.4,5 As a result, the interdisciplinary care of palliative care and hospice teams is benefiting more nursing home staff, family members, and residents at a time when they are facing the increased and urgent needs associated with end-of-life care and the dying process.6,7 However, there is considerable evidence that residents of nursing homes still are not receiving optimal palliative or end-of-life care.8e12 The article “Hospice in the nursing home: Perspectives of frontline nursing home staff,” by Dr Unroe et al13 in this issue of JAMDA, provides a good introduction to some of the benefits and challenges of providing end-of-life care to nursing home residents. It examines the long-standing and still very pertinent question of how to best provide comfort and quality of care to nursing home residents, many of whom would benefit from a greater focus on end-of-life care. This article nicely highlights the difference between how social work staff and nursing staff view the value of hospice as an adjunct to the care already being provided by the nursing home. Although most staff responded favorably regarding hospice care in the nursing homes, approximately one-third of the nursing staff rated coordination of care lower with hospice involvement. In addition, many qualitative comments provided examples of when hospice was felt to be unresponsive to patient needs. However, social work was much more universally positive concerning the care provided by hospices, representing an important opportunity for improvement in an interprofessional approach to palliative and end-of-life care in the nursing home. The study also provided support for the common belief that