Staff perceptions of end-of-life care in long-term care.
OBJECTIVE
Although residential care/assisted living facilities and nursing homes have increasingly become a significant site of death for older Americans, little is known about staff perceptions of end-of-life care, perceived need for improvement in care, and differences by type of setting.


METHODS
Ninety-nine staff provided their perceptions of end-of-life care for 99 decedents from 74 residential care/assisted living facilities and nursing homes in four states as part of a larger cohort study. Staff were interviewed retrospectively regarding care provided during residents' last month of life.


METHODS
Staff reported on 11 areas of end-of-life care, describing the importance of each area and the level of improvement they felt was indicated. Weighted "need for change" scores were calculated as the product of perceived importance and need for improvement.


RESULTS
Both residential care/assisted living and nursing home staff reported a need for more staff education and nursing assistant time, as well as more use of volunteers. The two lowest ranked items for both facility types were involvement of hospice and encouragement for staff to attend funeral services. Nursing home staff perceived a greater need for improvement than residential care/assisted living staff in all 11 areas.


CONCLUSIONS
Results underscore the staffing demands of end-of-life care across facility types, and staff desires to be able to provide quality care throughout the dying process.
Zimmerman
Sheryl
S
Cecil G. Sheps Center for Health Services Research, the School of Social Work, Chapel Hill, NC, 27599-3386, USA. Sheryl_Zimmerman@unc.edu
Sloane
Philip D
PD
Hanson
Laura
L
Mitchell
C Madeline
CM
Shy
Ann
A
D040561:Assisted Living Facilities; D001291:Attitude of Health Personnel; D015331:Cohort Studies; D006801:Humans; D008134:Long-Term Care; D009735:Nursing Homes; D013727:Terminal Care / Q000523:psychology*; D014481:United States