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The Gerontologist Advance Access published online on July 2, 2009
The Gerontologist, doi:10.1093/geront/gnp092
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© The Author 2009. Published by Oxford University Press on behalf of The Gerontological Society of America. All rights reserved. For permissions, please e-mail: journals.permissions@oxfordjournals.org.

Measuring End-of-Life Care Processes in Nursing Homes

Helena Temkin-Greener, PhD1,2, Nan (Tracy) Zheng, BS3, Sally A. Norton, PhD, RN4, Timothy Quill, MD5, Susan Ladwig, MPH5 and Peter Veazie, PhD6

2 Department of Community and Preventive Medicine, Center for Ethics, Humanities and Palliative Care
3 Department of Community and Preventive Medicine, University of Rochester School of Medicine and Dentistry, New York
4 School of Nursing, Center for Ethics, Humanities and Palliative Care, University of Rochester, New York
5 Department of Medicine, Center for Ethics, Humanities and Palliative Care
6 Department of Community and Preventive Medicine, University of Rochester School of Medicine and Dentistry, New York

1 Address correspondence to Helena Temkin-Greener, PhD, Department of Community and Preventive Medicine, Center for Ethics, Humanities and Palliative Care, University of Rochester School of Medicine and Dentistry, Box 644, 601 Elmwood Avenue, Rochester, NY 14642. E-mail: helena_temkin-greener{at}urmc.rochester.edu


  Abstract

Purpose: The objectives of this study were to develop measures of end-of-life (EOL) care processes in nursing homes and to validate the instrument for measuring them. Design and Methods: A survey of directors of nursing was conducted in 608 eligible nursing homes in New York State. Responses were obtained from 313 (51.5% response rate) facilities. Secondary data on structural characteristics of the nursing homes were obtained from the Online Survey Certification and Reporting System. Exploratory factor analyses and internal consistency reliability analyses were performed. Multivariate regression models with fixed and random effects were estimated. Results: Four EOL process domains were identified—assessment, delivery, communication and coordination of care among providers, and communication with residents and families. The scales measuring these EOL process domains demonstrated acceptable to high internal consistency reliability and face, content, and construct validity. Facilities with more EOL quality assurance or monitoring mechanisms in place and greater emphasis on EOL staff education had better scores on EOL care processes of assessment, communication and coordination among providers, and care delivery. Facilities with better registered nurse and certified nurse aide staffing ratios and those with religious affiliation also scored higher on selected care process measures. Implications: This study offers a new validated tool for measuring EOL care processes in nursing homes. Our findings suggest wide variations in care processes across facilities, which in part may stem from lack of gold standards for EOL practice in nursing homes.

Keywords: End of life, Assessment, Delivery, Communication, Practice

Received December 2, 2008; Accepted March 23, 2009

Decision Editor: William J. McAuley, PhD


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