Improving the Quality of End-of-Life Care in Long-Term Care Institutions

Purpose: A knowledge transfer program was carried out to improve knowledge in end-of-life care staff at all levels in residential care homes for the elderly, using a model similar to that developed for a non-acute care hospital setting. Methods: The program consisted of a series of seminars and on-site sharing sessions held in the hospital providing outreach support to residential care homes for the elderly (RCHEs), as well as case discussions in the RCHEs. Evaluation was carried out using a knowledge assessment questionnaire before and after the initiative, as well as recording RCHE staff feedback and in-depth interviews with selected residents and their family members. Results: Knowledge gaps among RCHE staff existed in the areas of mortality relating to chronic diseases, pain and use of analgesics, feeding tubes, dysphagia, sputum management, and attitudes towards end-of-life care issues, which improved after the program. From the qualitative study, RCHE staff highlighted knowledge and service gaps, issues relating to use of feeding tubes and refusal to eat, lack of confidence in managing the dying process, application of Advance Care Plan (ACP) in the RCHE setting, and the need for training in these areas. Residents and family members highlighted the preference for death over suffering, planning for death, misconceptions about life-sustaining treatments and the advance directive (AD) document, and service gaps in advance care planning. Conclusion: Considerable knowledge and service gaps exist among staff and residents of RCHEs, which can be improved by the hospital geriatric team providing services to RCHEs.