Preparedness for End of Life-a Survey of Jerusalem District Nursing Homes.
OBJECTIVE
To evaluate the quality of end-of-life (EOL) care in nursing homes.


METHODS
Survey and semistructured interviews.


METHODS
Jerusalem district nursing homes.


METHODS
Staff members of 28 long-term care and skilled nursing facilities in the Jerusalem area in Israel of various ethnic, religious, and administrative affiliations (N = 207).


METHODS
Qualitative analysis of semistructured interviews and statistical analysis of questionnaires.


RESULTS
Most staff members reported that EOL preferences were unknown for more than 90% of residents and that fewer than 10% had a healthcare proxy. Most staff members recalled conducting fewer than five EOL conversations over the past year with residents or family members and could recall fewer than five cases in which a resident was allowed to die in the nursing home. According to staff opinions the prevalence of tube feeding was estimated at greater than 10%, initiated because of aspiration, malnutrition, and understaffing, often against family's preferences. More than 25% of staff members believed that pain management was inadequate. Knowledge about management of chronic pain was poor in half of nurses and nearly one-third of physicians. Most staff would rather not receive the treatments they administered to residents.


CONCLUSIONS
Nursing homes in Jerusalem lack competency for quality EOL care, and there are multiple psychological, training, and policy challenges to improvement.
Department of Internal Medicine, Hadassah-Hebrew University Medical Center, Mount Scopus, Jerusalem, Israel.
Adir
A
Shaulov
Center for Clinical Quality and Safety, Hadassah-Hebrew University Medical Center, Ein Kerem, Jerusalem, Israel.
Meir
M
Frankel
Ministry of Health, Jerusalem, Israel.
Alan
A
Rubinow
Department of Geriatric Medicine, Hadassah-Hebrew University Medical Center, Mount Scopus, Jerusalem, Israel.
Yoram
Y
Maaravi
Center for Clinical Quality and Safety, Hadassah-Hebrew University Medical Center, Ein Kerem, Jerusalem, Israel.
Mayer
M
Brezis
D016223:Advance Directives / Q000706:statistics & numerical data*; D000368:Aged; D000369:Aged, 80 and over; D001291:Attitude of Health Personnel; D002983:Clinical Competence; D004750:Enteral Nutrition; D006801:Humans; D007407:Interviews as Topic; D007557:Israel; D008503:Medical Staff; D009735:Nursing Homes; D009740:Nursing Staff; D059408:Pain Management; D010166:Palliative Care; D057240:Patient Preference; D019727:Proxy / Q000706:statistics & numerical data*; D011785:Quality Assurance, Health Care; D011795:Surveys and Questionnaires
advance care planning; advance directives; advanced dementia; end of life; palliative care