Tuesday, October 20, 2015

Hospice Care: Nursing Home Staff Views (Research)

Staff views about healthcare play major roles in what they do, why they do it, and how they affect others. Nursing home staff perspectives regarding hospice care are particularly important because lives are literally at stake. As a hospice volunteer for many years in nursing homes, I was very aware of this relationship and the powerful impact of attitudes on resident care. More research in this area is both welcome and needed.

This research on nursing home staff hospice perspectives included views of 1,229 certified nursing assistants (CNAs), nurses, and social workers toward hospice care in 52 Indiana nursing homes. They responded to questions and open-ended prompts with these results:

1)  A majority of staff responded favorably regarding hospice care in nursing homes.

2)  About one-third of nursing home staff rated coordination of care lower than other aspects. Many comments highlighted examples of hospice being non-responsive to residents' needs. These represented important opportunities for improvement.

Based on my own readings and experiences as a hospice volunteer and former school administrator, three ways for improving hospice in nursing homes include more staff education, implementation, and monitoring of hospice practices. This must be ongoing, particularly in nursing homes with high staff turnover. 

Nursing home staff members who are focused on curing hospice residents may not readily embrace the hospice philosophy of non-curative care. For some, this is a major paradigm shift in thinking. It is critical that they commit to enhancing and maintaining their expertise in hospice practices. This includes the referral or non-referral of residents to hospice care and the timing of those referrals.

The quality of end-of-life care for any patients depends on the context in which the care is given. In the context of a nursing home, views of staff members regarding the hospice philosophy and the implementation of that philosophy greatly impact hospice residents’ experiences. Collaboration can work when hospices and nursing home leaders commit to operating strategically using communication, flexibility, and skills to match staffing to the nursing home environment. 

Read about who leaves hospice alive. Discharges can occur for several reasons:

Frances Shani Parker, Author
Becoming Dead Right: A Hospice Volunteer in Urban Nursing Homes is available in paperback and e-book editions in America and other countries at online and offline booksellers.


  1. Hi Frances. I'm so glad you posted about the perspective nursing home staff may or may not have about their roles in a hospice setting. It's one reason why it's so critical to visit facilities beforehand and make sure their culture and approach is right for the patient and their families. Without that upfront due diligence, you can't be sure what you're going to get.

  2. Laura, you are so right. A staff person who is only committed to curative care may think she should "save Mr. Jones' life" and try to force him to eat when he is imminently dying and not wanting to eat. It is important that hospice caregiving directions are followed.This requires ongoing education and monitoring.