Although hospice (H) care represents one of the fastest growing end-of-life services, its use in nursing homes (NH) is, overall, at a very low level. Many factors have been proposed as influential (e.g., psycho-social, socio-economic, regulatory, philosophical, geographical), but the context of use for H services in NHs is dense, multi-layered and poorly understood. Interestingly, little attention in the literature has been paid to the relationship between front line H and NH staff as they collaborate to provide end-of-life care for NH residents on the unit. Both NH and H staff are critical """"""""gatekeepers"""""""" in the flow of H services to residents who may benefit from them, yet the literature on the role of these staff in facilitating or inhibiting the use of such services is virtually non-existent. The purpose of the proposed pilot research project is to learn about the relationship between H and NH front-line staff, and how the interaction between them shapes and influences the delivery of H services to residents. Drawing on theory and method in cultural anthropology, the research seeks to learn the experience of providing H care from the perspective of both H and NH staff, and to explore the meaning this experience holds for both segments. Specifically, the research seeks: 1) to identify and define the circumstances and conditions that the two segments regard as meaningful in the delivery of hospice services in a LTC facility; 2) to identify and explore both segments' needs and wants in providing such care; 3) to explore the two segments' perceptions and understandings of the other segment; and 4) to learn what the two segments believe to be the critical pathways and barriers to providing quality end-of-life care to dying nursing home residents. Based on the information gained through this research, the aim of the proposed project is to advance our understanding of H delivery in the NH setting by developing a theoretical model of the relationship between the H provider and the NHs it serves. If we can understand how front line staff experience and interpret the meaning of providing H services in this context, we are in a better position to develop care delivery models that most accurately reflect the needs and aspirations of the participants involved. Such experienced-based models can help improve the quality of end of life care for nursing homes residents and their access to it.

National Institute of Health (NIH)
Agency for Healthcare Research and Quality (AHRQ)
Small Research Grants (R03)
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Health Research Disssemination and Implementation (HRDI)
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Hughes, Ronda
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Polisher Research Institute
North Wales
United States
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