title: Exploring End-of-Life Care in Veterans Affairs Community Living Centers.
abstract: OBJECTIVE
  To compare quality of end-of-life (EOL) care indicators and family evaluation of care in community living centers (CLCs) with that of EOL care in acute, intensive, and hospice and palliative care units.
  
  
  METHODS
  Retrospective chart review and survey with next of kin of recently deceased inpatients.
  
  
  METHODS
  Inpatient Veterans Affairs (VA) Medical Centers (N = 145), including 132 CLCs, across the United States.
  
  
  METHODS
  The chart review included all individuals who died in VA inpatient units (n = 57,397). Family survey results included data for 33,497 veterans.
  
  
  METHODS
  Indicators of optimal EOL care: palliative consultation in the last 90 days of life, contact with a chaplain, family contact with a chaplain, and emotional support given to family after death. The main outcome was a single Bereaved Family Survey item in which respondents provided a global evaluation of quality of EOL care (excellent to very good, good, fair to poor).
  
  
  RESULTS
  Family evaluations of overall EOL care and quality of EOL care indicators for veterans who died in CLCs were better than those of veterans dying in acute or intensive care units but worse than those dying in hospice or palliative care units.
  
  
  CONCLUSIONS
  Care in CLCs can be enhanced through the integration of palliative care practices. Future research should identify critical elements of enhancing EOL care in nursing homes.
authors: Performance Reporting and Outcomes Measurement to Improve the Standard of Care at End-of-life Center, Veterans Affairs Medical Center, Philadelphia, Pennsylvania; School of Nursing, University of Pennsylvania, Philadelphia, Pennsylvania.
authors: Mary
authors: M
authors: Ersek
authors: Joshua
authors: J
authors: Thorpe
authors: Hyejin
authors: H
authors: Kim
authors: Arwin
authors: A
authors: Thomasson
authors: Dawn
authors: D
authors: Smith
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002604:Chaplaincy Service, Hospital / Q000639:trends; D003625:Data Collection; D005190:Family; D005260:Female; D017051:Hospice Care / Q000639:trends; D006787:Hospitals, Veterans / Q000639:trends*; D006801:Humans; D008297:Male; D011787:Quality of Health Care; D012189:Retrospective Studies; D013727:Terminal Care / Q000639:trends*; D014481:United States
keywords: end-of-life care; nursing homes; palliative care; quality of care; veterans