Although nursing facilities seem to be roundly disliked and regulated, more than a quarter of people who live to age 65 will use a nursing facility for long-term care. Self-interest alone would seem to motivate teams to provide better care for Alzheimer's patients in nursing facilities.
A number of facilities have been quietly implementing innovations to enhance the environment both for those who live there and for those who serve them. This seems a natural place for vigorous quality improvement. The concerned caregiving team is already in place, measurement of effects is often easy, and opportunities for improvement abound. With encouragement from senior leadership, a little time for the caregiving team, and protection from adverse publicity regarding the data gathered, nursing homes could undoubtedly make major gains. Making those gains widespread will also require attention to ways to spread the news of innovations that make a real difference, since there are few forums for presenting what has been learned within the field.
The Washington Home, mentioned above, housed a hospice program. The caregiving teams in each program began to realize that they had some special expertise not shared by the other program. Not only did this lead to referring some dying cancer patients in the nursing home to hospice; it also led to skilled and experienced nursing home nurses serving as consultants to the hospice team when they started learning to support families as dementia patients died at home.
<<< Previous Next >>> [ Go Up ]
This online version of the book Improving Care for the End of Life: A Sourcebook for Health Care Managers and Clinicians is provided with permission of Americans for Better Care of the Dying [ www.abcd-caring.org ] and Oxford University Press. All rights reserved.
For further information on quality improvement in end-of-life care visit The Palliative Care Policy Center [ www.medicaring.org ].