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.
