Palliative Care Programs

Palliative care is available in only about 43% of skilled nursing facilities, according to a report of a nationwide survey completed by 316 directors of nursing administration in facilities representing various geographic regions, sizes, and nonprofit/for profit statuses. (Lester et al.) For-profit facilities were significantly more likely to provide palliative care and to have a palliative care medical director than nonprofit facilities. Of skilled nursing facilities with a palliative care program in place, 42% provided consultation by a physician certified in palliative care and 28% had a designated palliative care medical director.

Timely referral of nursing home residents for palliative care consultation remains an area for improvement. Despite a nationwide focus on efforts to improve transitions of care, most requests for palliative care consultations occur after the resident has been admitted to the nursing facility—only 23% of palliative care consultations are established in advance of the individual's admission.

Identifying residents for whom palliative care may be beneficial also remains a challenge. Slightly more than half of the survey respondents stated that residents with a diagnosis of cancer or end-stage dementia were usually referred for palliative care consultation, whereas referrals were least likely for residents with nonhealing pressure ulcers, severe/uncontrolled pain or nonpain symptoms, or a history of frequent hospital admissions.

The survey found that overall, social workers and nurses were more likely than others to suggest consideration of palliative care to residents and their families. However, in the largest facilities, social workers were more likely than physicians and nurses to initiate a discussion about palliative care with residents and their families and initiate consultation, a result that the study authors found "surprising." Physicians and nurses are expected to recognize morbidities that would make a resident an appropriate candidate for palliative care and are more likely to have a relationship with the resident that could foster discussion of palliative care. According to survey respondents, residents of skilled nursing facilities rarely request a palliative care consultation themselves.

The report's authors raise questions about the quality of palliative care provided and the "legitimacy" of palliative care...