Monday, April 23, 2012
Rural vs. Urban End-of-Life Care (Nursing Home Research, Video 1:37)
Dying is universal, but what about differences and similarities in end-of-life (EOL) care? Most of my nursing home experiences with hospice care have been in an urban area. I was curious about this University of Rochester, NY research that compared rural and urban end-of-life care in nursing homes.
The purpose of this study by the University of Rochester, NY was to examine urban-rural differences in end-of-life quality of care provided to nursing home residents. A national sample of nursing homes was used. Three measured areas of focus were in-hospital death, hospice referral before death, and presence of severe pain.
Research results indicated there were urban-rural differences for in-hospital death and hospice quality measures, but not for pain. Compared with nursing homes located in urban areas, facilities in smaller towns and in isolated rural areas had significantly worse EOL quality for in-hospital death and hospice use. Differences were not statistically significant between facilities located in small towns and isolated rural areas.
According to the report, this study provides “empirical evidence for urban-rural differences in EOL quality of care using a national sample of nursing homes.” This research data is important because it serves as a necessary first step toward improving EOL care for dying nursing home residents and for bridging the urban-rural gap.
This video titled End of Life: Burdensome Transitions from Brown University refers to another EOL study that addresses health care transitions such as moves from the nursing home to the hospital. These burdensome transitions can result in medical errors and lack of care coordination. For persons with advanced dementia, they can cause emotional distress and agitation. According to this study, such transitions are not consistent with goals of providing dying patients with comfort, and a fifth of them experience at least one during their last three months. African Americans and Hispanics were more likely than whites to experience these burdensome transitions.
Frances Shani Parker, Author
Becoming Dead Right: A Hospice Volunteer in Urban Nursing Homes is available in paperback at many booksellers and in e-book form at Amazon and Barnes and Noble booksellers.