Factors that influence end-of-life care in nursing homes: the physical environment, inadequate staffing, and lack of supervision.
OBJECTIVE
This study investigated the physical environment and organizational factors that influenced the process of providing care to terminally ill nursing home residents.


METHODS
Participant observation, interviews, and event analysis were used to obtain data in two proprietary facilities.


RESULTS
The physical environment was not conducive to end-of-life care. The rooms were crowded, there was little privacy, and the facilities were noisy. Inadequate staffing and lack of supervision were among the most significant organizational factors that influenced care. Often, residents did not receive basic care, such as bathing, oral hygiene, adequate food and fluids, and repositioning. A consequence of inadequate staffing was the development of pressure ulcers; 54% of the residents had pressure ulcers; 82% of these residents died with pressure ulcers.


CONCLUSIONS
Findings suggest that the nursing home environment in these two facilities, as now structured, is an inappropriate setting for end-of-life care.
Kayser-Jones
Jeanie
J
Depaertment of Physiological Nursing, University of California-San Francisco, 2 Kirkham Street, Room N631, San Francisco, CA 94143-0610, USA. jeanie.kayser-jones@nursing.ucsf.edu
Schell
Ellen
E
Lyons
William
W
Kris
Alison E
AE
Chan
Joyce
J
Beard
Renée L
RL
D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006707:Homes for the Aged / Q000458:organization & administration / Q000592:standards*; D006801:Humans; D008297:Male; D009735:Nursing Homes / Q000458:organization & administration / Q000592:standards*; D013727:Terminal Care / Q000592:standards*; D014481:United States; D000078329:Workforce