Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2009 Dec;49(6):803-15.
doi: 10.1093/geront/gnp092. Epub 2009 Jul 2.

Measuring end-of-life care processes in nursing homes

Helena Temkin-Greener  1 , Nan Tracy Zheng, Sally A Norton, Timothy Quill, Susan Ladwig, Peter Veazie
Affiliations

Measuring end-of-life care processes in nursing homes

Helena Temkin-Greener et al. Gerontologist. 2009 Dec.

Abstract

Purpose: The objectives of this study were to develop measures of end-of-life (EOL) care processes in nursing homes and to validate the instrument for measuring them.

Design and methods: A survey of directors of nursing was conducted in 608 eligible nursing homes in New York State. Responses were obtained from 313 (51.5% response rate) facilities. Secondary data on structural characteristics of the nursing homes were obtained from the Online Survey Certification and Reporting System. Exploratory factor analyses and internal consistency reliability analyses were performed. Multivariate regression models with fixed and random effects were estimated.

Results: Four EOL process domains were identified-assessment, delivery, communication and coordination of care among providers, and communication with residents and families. The scales measuring these EOL process domains demonstrated acceptable to high internal consistency reliability and face, content, and construct validity. Facilities with more EOL quality assurance or monitoring mechanisms in place and greater emphasis on EOL staff education had better scores on EOL care processes of assessment, communication and coordination among providers, and care delivery. Facilities with better registered nurse and certified nurse aide staffing ratios and those with religious affiliation also scored higher on selected care process measures.

Implications: This study offers a new validated tool for measuring EOL care processes in nursing homes. Our findings suggest wide variations in care processes across facilities, which in part may stem from lack of gold standards for EOL practice in nursing homes.

PubMed Disclaimer

Figures

Figure 1.
Figure 1.
End-of-life quality of care in nursing homes: Conceptual framework.
See this image and copyright information in PMC

Similar articles

See all similar articles

Cited by

See all "Cited by" articles

References

    1. Brazil K, Krueger P, Bedard M, Kelley M, McAiney C, Justice C, et al. Quality of care for residents dying in Ontario long-term care facilities: Findings from a survey of directors of care. Journal of Palliative Care. 2006;22:18–25. - PubMed
    1. Buchanan J, Murkofsky R, O’Malley A, Karon S, Zimmerman D, Caudry D, et al. Nursing home capabilities and decisions to hospitalize: A survey of medical directors and directors of nursing. Journal of the American Geriatrics Society. 2006;54:458–465. - PubMed
    1. Carter MW, Porell FW. Variations in hospitalization rates among nursing home residents: The role of facility and market attributes. Gerontologist. 2003;43:175–191. - PubMed
    1. Castle N. Advance directives in nursing homes: Resident and facility characteristics. Omega: Journal of Death and Dying. 1997;34:321–332. - PubMed
    1. Castle N, Mor V. Hospitalization of nursing home residents: A review of the literature. Medical Care Research and Review. 1996;53:123–148. - PubMed

Publication types