Challenges to providing end-of-life care to low-income elders with advanced chronic disease: lessons learned from a model program.
OBJECTIVE
This study explored the challenges in providing end-of-life care to low-income elders with multiple comorbid chronic conditions in a fully "integrated" managed care program, and it highlighted essential recommendations.


METHODS
A case-study design was used that involved an extensive analysis of qualitative data from five focus groups with interdisciplinary team members, two in-depth interviews with administrators, and open-ended survey responses from social workers detailing death experiences of 120 elders.


RESULTS
Seven major themes characterized primary end-of-life care challenges: (a) the nature of advanced chronic disease; (b) the incapacity of support systems; (c) barriers to honoring care preferences; (d) challenges with characteristics and needs of participants; (e) needs of complex family systems; (f) barriers with transitions; and (g) barriers with culture and language.


CONCLUSIONS
The lessons learned suggest recommendations with implications for program development, practice, policy, and future research.
Kramer
Betty J
BJ
University of Wisconsin-Madison School of Social Work, 53706, USA. ejkramer@wisc.edu
Auer
Casey
C
D000369:Aged, 80 and over; D016022:Case-Control Studies; D002908:Chronic Disease; D005260:Female; D017144:Focus Groups; D006297:Health Services Accessibility / Q000191:economics*; D006801:Humans; D008297:Male; D008329:Managed Care Programs / Q000191:economics; D020380:Needs Assessment / Q000191:economics*; D010166:Palliative Care; D011203:Poverty; D015397:Program Evaluation; D036301:Qualitative Research; D012947:Social Work; D011795:Surveys and Questionnaires; D013727:Terminal Care / Q000191:economics*; D014481:United States