1
|
Leclerc-Loiselle J, Gendron S, Daneault S. Nursing activities for health promotion in palliative home care: an integrative review. Palliat Care Soc Pract 2024; 18:26323524241235191. [PMID: 38487793 PMCID: PMC10938613 DOI: 10.1177/26323524241235191] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2023] [Accepted: 02/08/2024] [Indexed: 03/17/2024] Open
Abstract
Palliative care in community contexts is undergoing significant change as a result of public policy and new models of care, which link health promotion principles with palliative care practices. These models support the creation of partnerships between formal care structures and the communities in which care is provided. Given the central role of nurses in the institutional delivery of palliative care, particularly in the home, it is important to provide a systematic description of the activities of nurses that fall within the principles of health promotion. The objective was to describe the diverse range of nursing activities for health promotion that are provided in the palliative home care setting. This is an integrative review. Fifty-five studies listed in the MEDLINE, CINAHL and EMBASE databases, and published between 1999 and December 2022, were identified. Data analysis and presentation of the results were guided by Kellehear's Health-Promoting Palliative Care (HPPC) model. Six themes were identified to describe nursing activities for health promotion in the context of palliative home care: creating a meaningful relationship, supplying medical information, promoting self-care throughout the trajectory, providing emotional support, involving professional or community services and supporting change. The findings point to nurses focusing more on the individual context and on direct care. The relationship with communities in which they work remains unidirectional. However, some HPPC principles are relevant to nursing activities through the contextualization of nurses' actions and their moral responsibility to work towards the respect of patient's values. Being poorly described, how nurses can truly engage their practice towards health-promoting principles, such as the enhancement of support and control over their lives for people living with serious illness, still requires further empirical research.
Collapse
Affiliation(s)
- Jérôme Leclerc-Loiselle
- School of Nursing, Université de Sherbrooke, 150, Pl. Charles-Le Moyne, L1-7730, Longueuil, QC J4K 0A8, Canada
- Faculty of Nursing, Université de Montréal, Montreal, QC, Canada
- Réseau québécois de recherche en soins palliatifs et de fin de vie (RQSPAL), Québec, QC, Canada
| | - Sylvie Gendron
- Faculty of Nursing, Université de Montréal, Montreal, QC, Canada
| | - Serge Daneault
- Department of Family and Emergency Medicine, Université de Montréal, Montreal, QC, Canada
- Research centre of Institut universitaire de gériatrie de Montréal, Montréal, QC, Canada
- Integrated University Health and Social Services Centre of Centre-Sud-de-l’Île-de-Montréal, Montréal, QC, Canada Réseau québécois de recherche en soins palliatifs et de fin de vie (RQSPAL), Québec, QC, Canada
| |
Collapse
|
2
|
Cotton A, Sayers J, Green H, Magann L, Paulik O, Sikhosana N, Fernandez R, Foster J. Older persons' perceptions and experiences of community palliative care: a systematic review of qualitative evidence. JBI Evid Synth 2024; 22:234-272. [PMID: 37930393 PMCID: PMC10871598 DOI: 10.11124/jbies-22-00353] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2023]
Abstract
OBJECTIVE The objective of this review was to critically appraise and synthesize qualitative evidence of older persons' perceptions and experiences of community palliative care. INTRODUCTION Palliative care focuses on the relief of symptoms and suffering at the end of life and is needed by approximately 56.8 million people globally each year. An increase in aging populations coupled with the desire to die at home highlights the growing demand for community palliative care. This review provides an understanding of the unique experiences and perceptions of older adults receiving community palliative care. INCLUSION CRITERIA This review appraised qualitative studies examining the perceptions and experiences of older adults (65 years or older) receiving community palliative care. Eligible research designs included, but were not limited to, ethnography, grounded theory, and phenomenology. METHODS A search of the literature across CINAHL (EBSCOhost), MEDLINE (Ovid), Embase (Ovid SP), Web of Science Core Collection, and Scopus databases was undertaken in July 2021 and updated November 1, 2022. Included studies were published in English between 2000 and 2022. The search for unpublished studies included ProQuest Dissertations and Theses. Study selection, quality appraisal, and data extraction were performed by 2 independent reviewers. Findings from the included studies were pooled using the JBI meta-aggregation method. RESULTS Nine qualitative studies involving 98 participants were included in this review. A total of 100 findings were extracted and grouped into 14 categories. Four synthesized findings evolved from these categories: i) Older persons receiving palliative care in the community recognize that their life is changed and come to terms with their situation, redefining what is normal, appreciating life lived, and celebrating the life they still have by living one day at a time; ii) Older persons receiving palliative care in the community experience isolation and loneliness exacerbated by their detachment and withdrawal from and by others; iii) Older persons receiving palliative care in the community face major challenges managing prevailing symptoms, medication management difficulties, and costs of medical care and equipment; and iv) Older persons want to receive palliative care and to die at home; however, this requires both informal and formal supports, including continuity of care, good communication, and positive relationships with health care providers. CONCLUSIONS Experiences and perceptions of community palliative care vary among older adults. These are influenced by the individual's expectations and needs, available services, and cost. Older adults' input into decision-making about their care is fundamental to their needs being met and is contingent on effective communication between the patient, family, and staff across services. Policy that advocates for trained palliative care staff to provide care is necessary to optimize care outcomes, while collaboration between staff and services is critical to enabling holistic care, managing symptoms, and providing compassionate care and support.
Collapse
Affiliation(s)
- Antoinette Cotton
- School of Nursing and Midwifery, Western Sydney University, Sydney, NSW, Australia
- The New South Wales Centre for Evidence Based Health Care: A JBI Affiliated Group, Western Sydney University, Penrith, NSW, Australia
| | - Jan Sayers
- School of Nursing and Midwifery, Western Sydney University, Sydney, NSW, Australia
| | - Heidi Green
- School of Health and Society, University of Wollongong, Wollongong, NSW, Australia
- Centre for Transformative Nursing, Midwifery and Health Research: A JBI Affiliated Group, The University of Newcastle, Gosford, NSW, Australia
| | | | | | - Nqobile Sikhosana
- The New South Wales Centre for Evidence Based Health Care: A JBI Affiliated Group, Western Sydney University, Penrith, NSW, Australia
| | - Ritin Fernandez
- Centre for Transformative Nursing, Midwifery and Health Research: A JBI Affiliated Group, The University of Newcastle, Gosford, NSW, Australia
- University of Newcastle, Newcastle, NSW, Australia
| | - Jann Foster
- School of Nursing and Midwifery, Western Sydney University, Sydney, NSW, Australia
- The New South Wales Centre for Evidence Based Health Care: A JBI Affiliated Group, Western Sydney University, Penrith, NSW, Australia
- University of Canberra, Canberra, ACT, Australia
- Ingham Research Institute, Liverpool, NSW, Australia
| |
Collapse
|
3
|
Costello J. The role of informal caregivers at the end of life: providing support through Advance Care Planning. Int J Palliat Nurs 2017; 23:60-64. [PMID: 28245168 DOI: 10.12968/ijpn.2017.23.2.60] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
In the palliative phase of a person's illness, the needs of the patient and informal caregivers are paramount. Caregivers often look to palliative care practitioners for support, guidance and emotional comfort. This article reviews the role of the informal caregiver at the end of life, summarising their concerns and needs. The paper also highlights caregiver difficulties in making the coping transition when the patient's medical condition becomes advanced and they require end-of-life care. The focus of the review is placed on discussions about Advanced Care Planning (ACP). ACP is a complex legal, ethical and practical issue that can enable caregivers to consider future strategies and enable them to provide high quality care at the end of life. The paper looks at some of the ethical and legal issues associated with this sensitive end-of-life issue.
Collapse
Affiliation(s)
- John Costello
- Associate Professor, Nanyang polytechnic, Singapore SIT@NYP (University of Manchester)
| |
Collapse
|
4
|
Johnston B, Papadopoulou C, Östlund U, Hunter K, Andrew J, Buchanan D. What’s Dignity Got To Do With It? Patient Experience of the Dignity Care Intervention. SAGE Open Nurs 2017. [DOI: 10.1177/2377960817699839] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Affiliation(s)
- Bridget Johnston
- School of Medicine, Dentistry & Nursing, College of Medical, Veterinary & Life Sciences, University of Glasgow and NHS Greater Glasgow and Clyde, Glasgow, Scotland
| | | | - Ulrika Östlund
- Department of Health and Caring Sciences, Linnaeus University, Sweden
| | | | | | | |
Collapse
|
5
|
Affiliation(s)
- Brian Nyatanga
- Senior Lecturer in Allied Professional Studies and Lead for The Centre for Palliative Care, University of Worcester
| |
Collapse
|
6
|
Reed FM, Fitzgerald L, Bish MR. Rural District Nursing Experiences of Successful Advocacy for Person-Centered End-of-Life Choice. J Holist Nurs 2016; 35:151-164. [DOI: 10.1177/0898010116646643] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Choices in care during the end stages of life are limited by the lack of resources and access for rural people. Nursing advocacy based on the holistic understanding of people and their rural communities may increase the opportunity for choice and improve the quality of care for people living and dying at home. Pragmatism and nurse agency theory were used for a practical exploration of how district nurses successfully advocate for rural Australian end-of-life goals to begin the development of a practice model. In two stages of data collection, rural district nurse informants ( N = 7) were given the opportunity to reflect on successful advocacy and to write about their experiences before undertaking further in-depth exploration in interviews. They defined successful advocacy as “caring” that empowers people in the “big and small” personal goals important for quality of life. The concepts described that enable successful advocacy were organized into a network with three main themes of “willing” investment in holistic person-centered care, “knowing” people and resources, and feeling “supported.” The thematic network description provides deep insight into the emotional skill and moral agency involved in successful end-of-life nurse advocacy and can be used as a sound basis for modeling and testing in future research.
Collapse
|
7
|
Johnston B, Pringle J, Buchanan D. Operationalizing reflexivity to improve the rigor of palliative care research. Appl Nurs Res 2015; 31:e1-5. [PMID: 26620579 DOI: 10.1016/j.apnr.2015.10.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2015] [Accepted: 10/26/2015] [Indexed: 11/30/2022]
Abstract
Reflective practice involves deliberate consideration of actions, attitudes and behaviors. Reflexivity in research is considered important for ensuring that research is ethically and rigorously conducted. This paper details the challenges of conducting research involving patients with palliative care needs within the acute hospital environment. It discusses the contribution of reflexivity to a pilot study using the Patient Dignity Question (PDQ) "What do I need to know about you as a person to take the best care of you that I can?" as a brief intervention to foster a more person-centered climate. Challenges that emerged are discussed from the perspectives of the researchers, the participants, and the setting; they relate to: timing and recruitment, the nature of palliative care illness, attitudes to research, and the research environment. Awareness of such issues can prompt researchers to devise appropriate strategies and approaches that may inform and assist the rigor and conduct of future research.
Collapse
Affiliation(s)
- Bridget Johnston
- Sue Ryder Care Centre for the Study of Supportive, Palliative and End of Life Care, The University of Nottingham, Queen's Medical Centre, Nottingham NG7 2HA.
| | - Jan Pringle
- University of Dundee and University of Nottingham, School of Nursing and Midwifery, Airlie Place, Dundee
| | | |
Collapse
|
8
|
Hill H, Evans JM, Forbat L. Nurses respond to patients' psychosocial needs by dealing, ducking, diverting and deferring: an observational study of a hospice ward. BMC Nurs 2015; 14:60. [PMID: 26582969 PMCID: PMC4650322 DOI: 10.1186/s12912-015-0112-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2014] [Accepted: 11/09/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Psychosocial support is considered a central component of nursing care but it remains unclear as to exactly how this is implemented in practice. The aim of this study was to provide a descriptive exploration of how psychosocial needs (PNs) of patients in a hospice ward are expressed and met, in order to develop an understanding of the provision of psychosocial support in practice. METHODS An embedded mixed-methods study was conducted in one hospice ward. Data collection included observations of patients' expressions of PNs and nurses' responses to those expressed PNs, shift hand-overs and multi-disciplinary meetings. Interviews about the observed care were conducted with the patients and nurses and nursing documentation pertaining to psychosocial care was collated. Descriptive statistical techniques were applied to quantitative data in order to explore and support the qualitative observational, interview and documentary data. RESULTS During the 8-month period of observation, 227 encounters within 38 episodes of care were observed among 38 nurses and 47 patients. Within these encounters, 330 PNs were expressed. Nurses were observed immediately responding to expressed PNs in one of four ways: dealing (44.2 %), deferring (14.8 %), diverting (10.3 %) and ducking (30.7 %). However, it is rare that one type of PN was clearly expressed on its own: many were expressed at the same time and usually while the patient was interacting with the nurse for another reason, thus making the provision of psychosocial support challenging. The nurses' response patterns varied little according to type of need. CONCLUSIONS The provision of psychosocial support is very complex and PNs are not always easily recognised. This study has allowed an exploration of the actual PNs of patients in a hospice setting, the way in which they were expressed, and how nurses responded to them. The nurses faced the challenge of responding to PNs whilst carrying out the other duties of their shift, and the fact that nurses can provide psychosocial support as an inherent component of practice was verified. The data included in this paper, and the discussions around the observed care, provides nurses everywhere with an example against which to compare their own practice.
Collapse
Affiliation(s)
- Hazel Hill
- School of Health Sciences, University of Stirling, Stirling, FK9 4LA UK
| | - Josie Mm Evans
- School of Health Sciences, University of Stirling, Stirling, FK9 4LA UK
| | - Liz Forbat
- Australian Catholic University and Calvary Health Care, Canberra, 2600 Australia
| |
Collapse
|
9
|
Offen J. The role of UK district nurses in providing care for adult patients with a terminal diagnosis: a meta-ethnography. Int J Palliat Nurs 2015; 21:134-41. [DOI: 10.12968/ijpn.2015.21.3.134] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- John Offen
- Community Staff Nurse, York Teaching Hospitals NHS Foundation Trust, York, UK
| |
Collapse
|
10
|
Norell Pejner M, Ziegert K, Kihlgren A. Older patients in Sweden and their experience of the emotional support received from the registered nurse--a grounded theory study. Aging Ment Health 2015; 19:79-85. [PMID: 24963781 DOI: 10.1080/13607863.2014.917605] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
OBJECTIVES This study intends to explore older patients' experiences of the emotional support received from registered nurses (RNs). We also aimed to gain deeper knowledge about the process of how getting the support they need is managed by the patient. METHODS The study was conducted using the grounded theory method. Data were collected by interviewing 18 patients between 80 and 96 years old. RESULTS Reasons why older patients experienced the emotional support received from the RN are reflected in the categories 'Meets my needs when I am irresolute', 'Meets my needs when I am vulnerable' and 'Meets my needs when I am in need of sympathy'. Reasons to the emotional support resulted in that patients experienced 'A sense of being able to hand over', which is therefore the core category of this study. CONCLUSION Older patients' experiences of emotional support are about obtaining relief. Patients were active participants and had strategies for which they wanted to share their emotions with the RN. In order to develop participatory care for older patients, we need more knowledge about how emotional support can be used as a nursing intervention.
Collapse
|
11
|
Reed FM, Fitzgerald L, Bish MR. District nurse advocacy for choice to live and die at home in rural Australia: a scoping study. Nurs Ethics 2014; 22:479-92. [PMID: 24981253 DOI: 10.1177/0969733014538889] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Choice to live and die at home is supported by palliative care policy; however, health resources and access disparity impact on this choice in rural Australia. Rural end-of-life home care is provided by district nurses, but little is known about their role in advocacy for choice in care. OBJECTIVES The study was conducted to review the scope of the empirical literature available to answer the research question: What circumstances influence district nurse advocacy for rural client choice to live and die at home?, and identify gaps in the knowledge. METHOD Interpretive scoping methodology was used to search online databases, identify suitable studies and select, chart, analyse and describe the findings. RESULTS 34 international studies revealed themes of 'the nursing relationship', 'environment', 'communication', 'support' and 'the holistic client centred district nursing role. DISCUSSION Under-resourcing, medicalisation and emotional relational burden could affect advocacy in rural areas. CONCLUSION It is not known how district nurses overcome these circumstances to advocate for choice in end-of-life care. Research designed to increase understanding of how rural district nurses advocate successfully for client goals will enable improvements to be made in the quality of end-of-life care offered.
Collapse
|
12
|
Pejner MN, Ziegert K, Kihlgren A. Trying to cope with everyday life--emotional support in municipal elderly care setting. Int J Qual Stud Health Well-being 2012; 7:1-7. [PMID: 23237630 PMCID: PMC3522874 DOI: 10.3402/qhw.v7i0.19613] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/12/2012] [Indexed: 11/14/2022] Open
Abstract
Emotional support is considered to be important to older patients because it is a contributing factor to experiencing good health and it has been shown that it can prevent depression after a hip fracture. Opinions differ on whether emotional support falls within the field of nursing, and studies also show that nurses in an elderly home care setting fail when it comes to giving emotional support. The aim of this study was to explore reasons for registered nurses to give emotional support to older patients in a municipal home care setting. The study was conducted using Grounded Theory. Data collection was carried out through interviews with 16 registered nurses. The inclusion criteria were emotional support given to patients aged 80 years and above living in ordinary or sheltered housing and who were in need of help from both the home help service and registered nurses. The results show that the main concern of emotional support was “Trying to relieve the patient from their emotions so they are able to cope with everyday life.” This core category illustrates how registered nurses tried to support the patients’ own strength, so that they were able to move forward. Registered nurses consider that they could support the patients because they give them access to, or could create access to, their emotions, but there were also times when they felt helplessness and as a result, consciously opted out. The results also indicate that registered nurses were keen to give emotional support. To develop patient-centered elderly care, more knowledge of emotional support and the elderly's need for this support is required.
Collapse
|
13
|
Johnston B, Östlund U, Brown H. Evaluation of the Dignity Care Pathway for community nurses caring for people at the end of life. Int J Palliat Nurs 2012; 18:483-9. [PMID: 23123951 DOI: 10.12968/ijpn.2012.18.10.483] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND People nearing the end of life fear loss of dignity, and a central tenet of palliative care is to help people die with dignity. The Dignity Care Pathway (DCP) is an intervention based on the Chochinov theoretical model of dignity care. It has four sections: a manual, a Patient Dignity Inventory, reflective questions, and care actions. METHOD The feasibility and acceptability of the DCP were evaluated using a qualitative design with a purposive sample of community nurses. Data was collected from April to October 2010 using in-depth interviews, reflective diaries, and case studies and then analysed using framework analysis. RESULTS The DCP was acceptable to the community nurses, helped them identify when patients were at the end of life, identified patients' key concerns, and aided nurses in providing holistic end-of-life care. It requires the nurse to have excellent communication skills. Some of the nurses found it hard to initiate a conversation on dignity-conserving care. CONCLUSION The DCP helps nurses to deliver individualised care and psychological care, which has previously been identified as a difficult area for community nurses. All of the nurses wished to continue to use the DCP and would recommend it to others.
Collapse
Affiliation(s)
- Bridget Johnston
- School of Nursing and Midwifery, University of Dundee, 11 Airlie Place, Dundee DD1 4HJ, Scotland.
| | | | | |
Collapse
|
14
|
Karlsson M, Karlsson C, Barbosa da Silva A, Berggren I, Söderlund M. Community nurses' experiences of ethical problems in end-of-life care in the patient's own home. Scand J Caring Sci 2012; 27:831-8. [DOI: 10.1111/j.1471-6712.2012.01087.x] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2011] [Accepted: 08/13/2012] [Indexed: 11/29/2022]
Affiliation(s)
- Margareta Karlsson
- Department of Caring Science; Åbo Academy University; Vasa Finland
- Department of Nursing; Health and Culture, University West; Trollhättan Sweden
| | | | | | - Ingela Berggren
- Department of Nursing; Health and Culture, University West; Trollhättan Sweden
| | - Maud Söderlund
- Department of Caring Science; Åbo Academy University; Vasa Finland
| |
Collapse
|
15
|
Resnick HE, Hickman S, Foster GL. Documentation of advance directives among home health and hospice patients: United States, 2007. Am J Hosp Palliat Care 2011; 29:26-35. [PMID: 21576090 DOI: 10.1177/1049909111407627] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
This report provides nationally representative data on documentation of advance directives (ADs) among home health (HH) and hospice patients. Advance directives were recorded for 29% of HH patients and 90% of hospice discharges. Among HH patients, increasing age and use of assistive devices were associated with greater odds of having an AD, while being Hispanic or black (relative to white) and enrolled in Medicaid decreased the odds of having ADs. Among hospice discharges, being enrolled in Medicare and having 4 or 5 activities of daily living (ADL) limitations were associated with higher odds of ADs while depression, use of emergency services, and being black (relative to White) were associated with lower odds. Even after adjustment for potentially confounding factors, racial differences persist in AD documentation in both care settings.
Collapse
|
16
|
Resnick HE, Hickman SE, Foster GL. Advance Directives in Home Health and Hospice Agencies: United States, 2007. Am J Hosp Palliat Care 2011; 28:467-74. [DOI: 10.1177/1049909111399751] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
This report provides nationally representative data on policies, storage, and implementation of advance directives (ADs) in home health and hospice (HHH) agencies in the United States using the National Home and Hospice Care Survey. Federally mandated ADs policies were followed in >93% of all agencies. Nearly all agencies stored ADs in a file at the agency, but only half stored them at the patient’s residence. Nearly all agencies informed staff about the AD, but only 77% and 72% of home health agencies informed the attending physician and next-of-kin, respectively. Home health and hospice agencies are nearly universally compliant with ADs policies that are required in order to receive Medicare and Medicaid payments, but have much lower rates of adoption of ADs policies beyond federally mandated minimums.
Collapse
Affiliation(s)
- Helaine E. Resnick
- American Association of Homes and Services for the Aging, Washington, DC, USA
- Department of Medicine, Georgetown University, Washington, DC, USA
| | | | - Gregory L. Foster
- American Association of Homes and Services for the Aging, Washington, DC, USA
| |
Collapse
|