A profile of residents admitted to long-term care facilities for end-of-life care

Introduction: Permanent placement in a Long-Term-Care (LTC) facility following hospitalization or when staying at home is no longer a viable option is the reality for a growing number of Americans. When death is imminent, the specialized knowledge and skill of the hospice team is required and accepted as an important component of end-of-life (EOL) care. The provision of appropriate care at the EOL is contingent on accurate identification of those residents who are approaching the final stage of life. This study describes the prevalence, profile, and survivorship of residents admitted to LTC facilities, using the Minimum Data Set (MDS) designation of being at the EOL. Methods: A descriptive, correlational, retrospective cohort design was used to analyze all residents admitted to certified LTC facilities with hospice contracts in Missouri in 1999. Variables for analysis were selected from the MDS items that are clinically relevant for those residents at the EOL, for example, pain, incontinence, skin condition, activities of daily living (ADLs), depression, and weight loss. In addition, items regarding advance directives, use of special treatments, and diagnoses were selected because they are important to the care of residents at the EOL. Results: Of 492 eligible facilities, 159 were confirmed as providing hospice care. Of 9615 admissions to these facilities, 432 (4.5%) met the EOL care definition; half of these were receiving specialist hospice care. The EOL residents were distinguishable in terms of symptoms. Median survival time for EOL admissions was 33 days. At 6 months, only 17% of EOL admissions remained in the facility. Conclusions: Residents designated as EOL who are admitted to LTC are a distinct group from other new residents, with identifiable needs requiring specialist attention. Accurate recognition that EOL is imminent is required for the development of appropriate strategies and resources for care.