Identifying Patients in Need of Palliative Care in the Nursing Home Setting

Journal of Pain and Symptom Management · 2026-05-12

The Palliative Nursing Workforce: Current Status, Future Demands and Recommendations

Journal of Pain and Symptom Management · 2026-05-12

Palliative Care Needs of Older Adults With and Without Dementia During Post-Acute Care in Skilled Nursing Facilities.

UNC Libraries · 2026-04-22

Seriously ill older adults, including those living with Alzheimer's disease and related dementias (ADRD), often receive disease-focused rehabilitative care in skilled nursing facilities (SNF) with little consideration for their palliative care (PC) needs. Using baseline data from a pilot pragmatic clinical trial (<em>N</em> = 52), we conducted a cross-sectional study to compare the clinical characteristics and the PC needs of older adults with and without ADRD receiving SNF care. Functional decline was the most common global indicator for palliative care among both groups. While there was no statistically significant difference in PC needs between the two groups, the most prevalent PC needs for all were pain (63.5%), feeling anxious or worried (59.6%), family and friends being anxious or worried (57.7%), and need for information (46.2%). Older adults with and without an ADRD diagnosis who are admitted to post-acute SNF care may benefit from universal screening and tailored PC services.

Key informants’ perceptions of telehealth palliative care for people living with dementia in nursing homes

BMC Geriatrics · 2025-03-19 · 3 citations

BACKGROUND: Studies have shown that palliative care delivered to people living with dementia (PLWD) in nursing homes (NHs) improves care quality and reduces potentially burdensome treatments. However, access to palliative care services in NHs is uncommon. Telehealth may extend the reach of specialty palliative care consultation, yet strategies for feasible and acceptable NH implementation remain unknown. During implementation of an embedded pragmatic pilot clinical trial for PLWD, we aimed to describe key informants' perceptions of a NH telehealth palliative care intervention. METHODS: Guided by the Practical Implementation Sustainability Model (PRISM), we engaged key informants in 30-60-minute focus groups and individual semi-structured interviews to understand barriers and facilitators to implementation of a NH telehealth palliative care intervention in one NH. Interview prompts addressed contextual factors that influenced outcomes. Interviews were conducted and recorded via videoconference, transcribed, and analyzed using the Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) framework. RESULTS: Participants (n = 14) included NH administrators and other leaders, palliative care providers, telehealth representatives, dementia advocates, a care partner, and a PLWD. Identified barriers to implementation included stigma surrounding dementia, palliative care, and NHs; multiple logistical pieces required to implement the intervention; inflexibility of palliative care providers to meet NH needs; and inability to assess residents in person. Facilitators included convenient, user-friendly and readily available telehealth equipment, and NH staff presence during visits. Outcomes most relevant to the key informants were increased goals of care conversations, improved symptom management and quality of life, and decreased health care utilization. Suggested adaptations included increased family engagement in the logistics of the intervention and strong NH advocacy. CONCLUSIONS: In this study, key informants provided feedback that barriers to implementing NH telehealth palliative care far outweighed the facilitators for uptake. Future work will focus on employing NH staff in user centered design to overcome barriers such as optimal timing for consults and/or scheduled consult days to fit NH workflow, assessing organizational readiness for implementing change, and identifying dementia-specific and palliative care education needs.

Long-Term Care

2025-10-01

Abstract More than 1.3 million Americans live in nursing homes (NHs), and more than half of these residents require extensive assistance with bathing, dressing, toileting, and mobility. More than 85% of residents are aged 65 years or older, and more than 40% are 85 years or older. Therefore, quality end-of-life care in NHs is important. This chapter reviews the range of long-term care environments and provides details about the residents and the interdisciplinary team providers who care for them. It examines palliative care delivery through a description of models which support resident- and family-centered care in NHs. It also focuses on the challenges and facilitators for delivering palliative care services to NH residents with serious illness. The chapter concludes with a table of palliative care resources for staff working in this setting.

Evaluating the pragmatic characteristics of advance care planning outcome measures in dementia clinical trials: A scoping review

UNC Libraries · 2025-07-26

BACKGROUND: Advance care planning (ACP) is a process that involves discussing a person's goals, values, and preferences; it is particularly important for persons living with dementia (PLWD) given that dementia is incurable and progressive. To ensure results that will impact real-world practices, ACP outcome measures must be psychometrically strong, meaningful to key partners, and pragmatic to collect. Therefore, we conducted a scoping review of outcome measures utilized in ACP randomized controlled clinical trials (RCTs) enrolling PLWD or their care partners and evaluated their pragmatic characteristics. METHODS: We searched MEDLINE/PubMed, EMBASE, CINAHL, PsycINFO, and Web of Science for peer-reviewed ACP RCTs enrolling PLWD or their care partners from 2011 to 2021. We abstracted characteristics of primary and secondary outcome measures, including pragmatic characteristics using an adapted Psychometric and Pragmatic Evidence Rating Scale and ACP outcome domains using the standardized ACP Outcome Framework (i.e., process, action, healthcare, or quality of care). RESULTS: We included 21 ACP RCTs. Trials included 103 outcome measures (39 primary and 64 secondary), of which 11% measured process, 14% measured action, 49% measured healthcare, and 26% measured quality of care. Twenty-four (23%) outcome measures were highly pragmatic, the majority of which (67%) reflected healthcare outcome measures. Sixty-one (59%) outcomes were assessed as highly relevant to PLWD or their care partners. Only 20% (n&thinsp;=&thinsp;21) of outcome measures were embedded into clinical practice. Most (62%) RCTs were conducted in nursing homes, and 33% were focused PLWD with advanced stage disease. CONCLUSIONS: In RCTs testing ACP interventions to support PLWD, only 23% of outcome measures were highly pragmatic, and most of these measured healthcare utilizations. Outcome assessments were rarely integrated into the EHR during routine clinical care. New outcome measures that address the lived experience of PLWD and their care partners plus have high pragmatic characteristics are needed for embedded pragmatic clinical trials.

Ensuring Success: Mechanisms of Action of Clinical Site Champions

Innovation in Aging · 2025-12-01

Abstract Clinical champions are engaged to implement evidence-based practices in health care settings. Research indicates that the presence of a champion does not ensure project success; therefore, we sought to identify the characteristics of effective clinical champions. In a Department of Veterans Affairs (VA) quality improvement project, we utilized clinical champions to implement a goals of care conversation intervention with seriously ill Veterans in VA home based primary care (HBPC) and community nursing homes (CNHs). During the five-year project, we conducted interviews (N = 99) with clinical champions and leadership at 11 HBPC programs and six VA CNH programs. Guided by the Tailored Implementation in Chronic Diseases framework and Shea’s conceptual model of champion impact, we analyzed interview data to identify champion characteristics and site-level contextual factors that affected achievement of implementation outcomes. We also compared clinical champion characteristics between sites that were successful and not successful in achieving implementation outcomes. Eight HBPC programs (73%) and four CNH programs (67%) were fully successful in achieving implementation outcomes. Successful site champions were committed to serving as champions and believed in the importance of goals of care conversations and documenting Veterans’ life-sustaining treatment preferences. They spent more time engaging peers, providing support, and performing implementation activities. Most successful sites reported high levels of leadership support and engagement. These findings highlight important considerations for identifying and selecting champions that may help guide other implementation programs—including champion belief and commitment to implementing a new intervention, motivation to serve as a champion, and ability to engage peers.

Comprehensive Dementia Care Models: State of the Science and Future Directions

Research in Gerontological Nursing · 2025-01-01 · 12 citations

The rising prevalence of Alzheimer's disease and Alzheimer's disease–related dementias has led to renewed public discourse and policy changes in response to the care needs of persons living with dementia and their care partners. Comprehensive dementia care models are central to many recent policy initiatives, most notably the Centers for Medicare &amp; Medicaid Services Guiding an Improved Dementia Experience model. Gerontological nursing research is uniquely positioned to design and lead research investigating the effectiveness of these initiatives, as well as the dissemination and scaling of existing comprehensive dementia care models. The current Annual State of the Science Review provides an overview of the current state of comprehensive dementia care models in the United States and relevant policies. Challenges and opportunities for nursing education, research, and implementation across the translational research continuum are also outlined. [ Research in Gerontological Nursing, 18 (1), 7–16.]

Partnership to Study Palliative Care in Nursing Homes

Journal of Pain and Symptom Management · 2025-04-10

Variations in Palliative Care for Nursing Home Residents With and Without Dementia

Journal of Pain and Symptom Management · 2025-04-10