title: End-of-life care in residential care homes: a retrospective study of the perspectives of family members using the VOICES questionnaire.
abstract: BACKGROUND
  In Europe, residential care homes (RCHs) are replacing hospitals as the place where death occurs, and they play an important role in end-of-life (EOL) care.
  
  
  OBJECTIVE
  The aim was to describe the quality of care during the last 3 months and last 3 days of life of those who died in RCHs as reported by family members. We also investigated whether there were differences in the EOL care of younger patients (<85 years) vs. the oldest old patients (≥85 years) as reported by family members.
  
  
  METHODS
  A retrospective survey design.
  
  
  METHODS
  Deaths (n = 189) at 19 RCHs in one municipality in Sweden were included. Family members were sent the VOICES questionnaire 1 month after their elderly relative had died. Descriptive statistics were used.
  
  
  RESULTS
  In the last 3 days before death, most family members reported there was enough help with nursing (93%) and personal care (78.5%). Among the family members, 86% were told that the resident was likely to die shortly. Most (94.1%) of residents were reported to have died at their preferred place. No significant difference was found between age groups. Family members also reported that about half of the elderly had pain (46.5%) and 86.4% received treatment; 55.9% had breathlessness and 39.7% received treatment. Breathlessness was significantly (p = 0.01) more common in the younger group, and they were treated more often (p = 0.006) than the oldest old.
  
  
  CONCLUSIONS
  This study revealed an overall positive picture of personal and nursing care and communication. These findings indicate that the quality of EOL care at RCHs is high. Inadequate management was found for symptom relief the last days of life. This suggests that this subject merits further attention by care professionals. To achieve better quality of EOL care at RCHs, we emphasise the importance of systematically working to improve symptom relief.
authors.affiliation: Department of Nursing, Umeå University, Umeå, Sweden.
authors.forename: Sofia
authors.initials: S
authors.lastname: Andersson
authors.affiliation: Department of Nursing, Umeå University, Umeå, Sweden.|Department of Learning, Informatics, Management and Ethics/MMC, Karolinska Institutet, Stockholm, Sweden.
authors.forename: Olav
authors.initials: O
authors.lastname: Lindqvist
authors.affiliation: The Institute for Palliative Care, Lund University and Region, Skåne, Lund, Sweden.
authors.forename: Carl-Johan
authors.initials: CJ
authors.lastname: Fürst
authors.affiliation: Department of Nursing, Campus Skellefteå, Umeå University, Sweden.
authors.forename: Margareta
authors.initials: M
authors.lastname: Brännström
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005190:Family / Q000523:psychology*; D005260:Female; D019538:Health Care Surveys; D006707:Homes for the Aged / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009735:Nursing Homes / Q000706:statistics & numerical data*; D010166:Palliative Care / Q000458:organization & administration*; D011787:Quality of Health Care / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D011795:Surveys and Questionnaires; D013548:Sweden; D013727:Terminal Care / Q000458:organization & administration*
keywords: VOICES questionnaire; elderly; end of life; family members; palliative care; quality of care; residential care homes