Hospice Care in Nursing Homes: Does It Contribute to Higher Quality Pain Management?

• Published in: The Gerontologist Vol. 46; no. 3; pp. 325 - 333
• Main Authors: Kayser-Jones, Jeanie S., Kris, Alison E., Miaskowski, Christine A., Lyons, William L., Paul, Steven M.
• Format: Journal Article
• Language: English
• Published: United States Oxford University Press 01-06-2006; The Gerontological Society of America
• Subjects: Aged; Analgesics - administration & dosage; Comparative Analysis; Data Analysis; Drug therapy; Elderly; Female; Hospice; Hospice Care; Hospices (Terminal Care); Humans; Long Term Care; Narcotics - administration & dosage; Nursing home; Nursing Homes; Nursing Homes - organization & administration; Pain; Pain management; Pain Measurement - standards; Participant Observation; Performance Factors; Prospective Studies; Qualitative Research; Research Methodology; Research Needs; Residents; Statistical Analysis; United States > US
• ISSN: 0016-9013; 1758-5341
• DOI: 10.1093/geront/46.3.325

Purpose:The purpose of this study was to investigate pain management among 42 hospice and 65 non-hospice residents in two proprietary nursing homes. Design and Methods:In this prospective, anthropological, quantitative, and qualitative study, we used participant observation, event analysis, and chart review to obtain data. The Medication Quantification Scale was used in order to account for the prescription and administration of all analgesic medications. Results:Although 72% of residents experienced pain, we found no statistically significant differences in the proportion of hospice versus non-hospice residents (a) who had been prescribed opioids and co-analgesics, and (b) whose medication was administered around the clock or as needed. Limited physician availability, lack of pharmacologic knowledge, and limitations of nursing staff hindered pain management of both groups of residents. Implications:Although hospice care is of some benefit, pain management and high-quality end-of-life care is dependent upon the context in which it is provided. Given that between 1991 and 2001 Medicare expenditures for nursing home-based hospice care increased from $8.6 million to $21.8 million, the effectiveness of hospice-care programs in nursing homes warrants further study.