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Nursing Home Participation in End-of-Life Programs: United States, 2004

Department of Medicine, Georgetown University, Georgetown, Washington, DC, hresnick{at}aahsa.org, Institute for the Future of Aging Services, American Association of Homes and Services for the Aging, Washington, DC

Gregory L. Foster, MPH, MA

Institute for the Future of Aging Services, American Association of Homes and Services for the Aging, Washington, DC

Susan E. Hickman, PhD

School of Nursing, Oregon Health & Science University, Portland, Oregon

The purpose of this report is to define the extent to which US nursing homes (NH) participate in end-of-life programs, using a nationally representative, cross-sectional sample of US NH. Data on EoL programs including Five Wishes, Last Acts, and Physician Orders for Life-Sustaining Treatment (POLST) were collected. In 2004, 17.2% of NH reported participating in 1 or more of these programs, with the largest proportion participating in POLST (13.3%) and smaller proportions in Five Wishes (5.6%) and Last Acts (4.2%). Nursing homes were more likely to participate in EoL programs if they also offered specialty programs and staff training for hospice, end-of-life, pain management, and dementia services. In 2004, fewer than 1 in 5 US NH participated in an EoL program. However, facilities that had EoL programs were more likely to have programs and staff training for services related to EoL care, a finding that suggests a clustering of these programs, services, and training. Provision of appropriate staff training may be a key to expanding EoL program participation in skilled nursing.

Key Words: end-of-life care • nursing home • advance directive • survey • epidemiology

This version was published on October 1, 2009

American Journal of Hospice and Palliative Medicine®, Vol. 26, No. 5, 354-360 (2009)
DOI: 10.1177/1049909109333933


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