by Drs. Steve Lai and Tim Gieseke

For this year’s annual conference, Mastering Patient-Centered Care Through Improved Communication, Care Transitions, and Palliative Care, the key themes will be better communication and palliative care.  In our fast-paced, technology-driven medical world, the principles of good palliative care need to be spread to our nursing home staffs and physicians caring for this frail patient population.  Despite the rapid growth and impact of hospital palliative care programs in the past decade, a major gap in access to palliative care exists.  It is imperative that we improve palliative care access in the skilled nursing facility as it is one key component in the chain of continuity for palliative care in the community.

A growing number of seriously ill patients reside in SNF’s.  Currently, 20% of all deaths in our country occur in the SNF setting.  With the aging population, the SNF population will double to 3 million and 40% of deaths will occur in the SNF setting by 2030.  Palliative care can provide an extra layer of support for the nursing home physician and nursing staff, challenged by limited resources and overwhelmed frontline staff.

The research has shown several areas where palliative care can make a significant difference in improving quality of care.  Untreated or under-treated pain in nursing home residents is well documented, about 50%.  Advance care planning discussion are often not done or done poorly at most SNF’s.  Since 2008, the POLST Paradigm has been promoted with grant funding by the California HealthCare Foundation and agency support from the California Coalition for Compassionate Care.  POLST does not fix end-of-life care, but it has highlighted the importance of advance care planning in the SNF setting.  The POLST is more than a form as it represents an opportunity for more meaningful conversations with our patients. 

To help have meaningful conversations with your residents, we now have many options.  The POLST Coalition has developed many helpful tools on their web site (http://coalitionccc.org/nursing-homes.php ).  In addition, the INTERACT 3 tool kit has a good palliative care tool kit worth reviewing (http://interact2.net/tools_v3.aspx).   We also suggest the conversation project (http://theconversationproject.org/ ) and prepare for your care (https://www.prepareforyourcare.org/) web sites.  

With so many of our residents dying, we need to ensure that we have pathways that support a good death.  The Coalition for Compassionate care has developed the CARE Recommendations (http://coalitionccc.org/_pdf/nursing-homes/CARE_Recommendations_Final.pdf ) to help your facility respond to this tremendous need.  

This month, our annual meeting will address many of these ideas and help you decide the next steps for your facility.