Exploring End-of-Life Care in Veterans Affairs Community Living Centers

Abstract

ObjectivesTo compare quality of end-of-life (EOL) care indicators and family evaluation of care in community living centers (CLCs) with that of EOL care in acute, intensive, and hospice and palliative care units. DesignRetrospective chart review and survey with next of kin of recently deceased inpatients. SettingInpatient Veterans Affairs (VA) Medical Centers (N=145), including 132 CLCs, across the United States. ParticipantsThe chart review included all individuals who died in VA inpatient units (n=57,397). Family survey results included data for 33,497 veterans. MeasurementsIndicators of optimal EOL care: palliative consultation in the last 90days of life, contact with a chaplain, family contact with a chaplain, and emotional support given to family after death. The main outcome was a single Bereaved Family Survey item in which respondents provided a global evaluation of quality of EOL care (excellent to very good, good, fair to poor). ResultsFamily evaluations of overall EOL care and quality of EOL care indicators for veterans who died in CLCs were better than those of veterans dying in acute or intensive care units but worse than those dying in hospice or palliative care units. ConclusionCare in CLCs can be enhanced through the integration of palliative care practices. Future research should identify critical elements of enhancing EOL care in nursing homes.