Hospice care in nursing homes: does it contribute to higher quality pain management?
OBJECTIVE
The purpose of this study was to investigate pain management among 42 hospice and 65 non-hospice residents in two proprietary nursing homes.


METHODS
In this prospective, anthropological, quantitative, and qualitative study, we used participant observation, event analysis, and chart review to obtain data. The Medication Quantification Scale was used in order to account for the prescription and administration of all analgesic medications.


RESULTS
Although 72% of residents experienced pain, we found no statistically significant differences in the proportion of hospice versus non-hospice residents (a) who had been prescribed opioids and co-analgesics, and (b) whose medication was administered around the clock or as needed. Limited physician availability, lack of pharmacologic knowledge, and limitations of nursing staff hindered pain management of both groups of residents.


CONCLUSIONS
Although hospice care is of some benefit, pain management and high-quality end-of-life care is dependent upon the context in which it is provided. Given that between 1991 and 2001 Medicare expenditures for nursing home-based hospice care increased from dollar 8.6 million to dollar 21.8 million, the effectiveness of hospice-care programs in nursing homes warrants further study.
Kayser-Jones
Jeanie S
JS
Department of Physiological Nursing, University of California, San Francisco, 2 Koret Way, Box 0610, San Francisco, CA 94143-0610, USA. jeanie.kayser-jones@nursing.ucsf.edu
Kris
Alison E
AE
Miaskowski
Christine A
CA
Lyons
William L
WL
Paul
Steven M
SM
D000368:Aged; D000700:Analgesics / Q000008:administration & dosage; D005260:Female; D017051:Hospice Care; D006801:Humans; D009294:Narcotics / Q000008:administration & dosage; D009735:Nursing Homes / Q000458:organization & administration*; D010147:Pain Measurement / Q000592:standards*; D011446:Prospective Studies
D000700:Analgesics; D009294:Narcotics