Physicians Urged to Ensure Access

Physicians Urged to Ensure Access to Hospice for an Often 'Invisible' Population

Nursing homes are the permanent site of care for more than 1.5 million adults in the U.S., and the site of death for approximately one-third of the population. Physicians play a pivotal role in helping this often “invisible” and vulnerable population receive needed palliative and end-of-life care, according to the authors of an article published in the Journal of the American Medical Association.

“Given the stark reality that 30% of Americans will die in nursing homes and that more than half of nursing home residents will die within six months of admission, providing hospice or palliative care is essential.”

Hospice services “increase attention to pain management, improve communication with family members, and decrease hospitalization at the end of life,” according to the authors. Hence, physicians are urged to individualize their care of seriously ill nursing home patients, communicate prognosis, and document preferences for advance care planning.

Prognosis in a nursing home patient is determined mainly by medical condition and functional status, note the authors. The proportion of nursing home residents with four or more impairments in activities of daily living has risen from 35% in 1999 to a current 50%. Besides being seriously ill, socially isolated, and often cognitively impaired, many residents have difficulty finding a personal physician who will care for them through the course of their illness.

“Most nursing home residents are cared for by family physicians, general internists, and geriatricians who work part-time in the nursing home,” write the authors. If a patient’s physician does not plan to be the attending physician of record in the nursing home, he or she should arrange for an effective hand-off to an accepting physician, they urge.

Although 65% of nursing home residents have some form of advance directive, advance care planning is a continuous process, requiring ongoing discussion as prognosis and preferences change, state the authors. “Although one might think that this process is only the responsibility of the primary care physician, often cardiologists, oncologists, pulmonologists, neurologists, or other physicians caring for patients with advanced life-limiting diseases have the opportunity and responsibility to discuss life planning with their patients.”

“The nursing home is the last site of care for many disabled adults, yet it may be invisible to many who live in the community, as well as to officeand hospital-based health care professionals,” the authors suggest. “Nursing home residents are one of the most vulnerable populations and an opportunity for physicians to meet their professional mission.”

Resources for physicians interested in increasing proficiency in providing nursing home care are available online from the American Medical Directors Association at www.amda.com.

Source: “The Physician’s Role in Patients’ Nursing Home Care,” Journal of the American Medical Association; October 5, 2011; 306(13):1468-1478. Zweig SC, Popejoy LL, Parker-Oliver D, Meadows SE; Department of Family and Community Medicine, School of Medicine; and Interdisciplinary Center on Aging, University of Missouri, Columbia.