End-of-Life Care in U.S. Nursing Homes: Resident and Facility Factors that Predict Presence and Use of Services

Abstract

Research has demonstrated the benefits of nursing homes offering specialized end-of-life services for their residents. These benefits include improved symptom management and emotional support. Prior research has identified, however, that referrals and use of these specialized end-of-life services for nursing home residents is still quite minimal, leaving significant unmet needs for these individuals in their last days of life. The purpose of this study was to explore the resident and organizational factors that may serve as catalysts and barriers to providing quality end-of-life care in U.S. nursing homes. This study is a cross-sectional design utilizing secondary data from the 2004 National Nursing Home Survey. A logistic regression analysis and multi-level regression analyses were performed to explore predictors for the presence and use of end-of-life services in these facilities. There were several facility variables that predicted the presence of end-of-life services in the facilities. Facilities that were for-profit, larger in size, and participated in end-of-life planning initiatives were more likely to offer end-of-life services. Facility geographic location was also a predictor with those nursing homes located in the West being less likely to offer end-of-life services. Factors specific to the nursing home resident that predicted utilization of end-of-life services included older age, decreased bed mobility, reports of pain, indicators of emotional distress (depression, sadness, or anxiety), and specific diagnoses (neoplasms and respiratory diseases). Having an advanced directive in place also increased the resident's odds of utilizing EOL services. Residents with primary payment sources of Medicare and Medicaid were found to be less likely to utilize services. With one-fifth of the deaths in the United States occurring in nursing home facilities, it is essential to ensure that quality end-of-life programs are in place to address the needs of the residents. Understanding the potential barriers for both the nursing home in implementing programs and the resident in accessing the services is essential in developing strategies for policies and procedures for quality end-of-life care.