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.

Hospice and Nursing Homes Blog

Family and Friends Rate End-of-Life Patient Care in Nursing Homes (Research, Hospice Video 1:00)

As much as people say they plan to die at home, most are dying in hospitals and nursing homes. What roles do family and friends who are patient advocates play? How do they feel about their experiences while their loved one is dying? Answers to these questions were topics for research at Brown University.

Telephone interviews were held with 54 close family members or friends of individuals who had spent at least 48 hours in the last month of life of a loved one in a nursing home. Respondents described the last year of life with the deceased loved one and their nursing home experiences.

These were the key themes of their areas of concern:

1)   Families often felt the need to advocate for their dying relative because of low expectations or experiences with poor quality nursing home care.

2)    They noted staff members who did not fully inform them about what to expect in the dying process.

3)    Respondents reported burden and gratification in care they themselves provided which sometimes entailed collaboration with staff.

4)    Interviews also identified ways hospice care impacted families, including helping to relieve family burden.

These themes highlight the urgent need for a reduction in the family’s burden at this critical stage of caregiving a dying loved one. Also needed is improved communication so families can be better prepared at the end of the loved one's life. This includes more information about hospice care. The family’s trust in the nursing home depends on how these supports are enhanced to make their experience with a dying loved one beautiful for everyone.

This one-minute video titled “PSA #9 Nursing Home Hospice QT.mov” is funded by the Pennsylvania Department of Aging and produced by the Take Charge Partnership. The scenario presented introduces a family member to hospice care for their loved one.

Frances Shani Parker, Author

"Becoming Dead Right: A Hospice Volunteer in Urban Nursing Homes” (paperback, e-book)

“Hospice and Nursing Homes Blog”