Grant: Project Grant

Nursing homes are important sites of care for people who can no longer live safely in their own homes. The majority of people who enter a nursing home will die there, meaning that nursing homes should be experts in providing quality end of life care. Unfortunately, nursing home care at the end of life has received little attention. As a result, nursing home residents at the end of life often receive aggressive, distressing treatments that are inconsistent with an optimal end of life care approach, and they frequently suffer from distressing, yet treatable, symptoms (such as pain, shortness of breath or pressure ulcers). Accurately measuring and monitoring such care practices and distressing symptoms is important to reduce their occurrence, and improve quality of end of life care in nursing homes. Most provinces mandate the use of a comprehensive clinical assessment tool (the Resident Assessment Instrument - Minimum Data set 2.0, RAI-MDS 2.0), which is regularly used to assess quality; however, outcomes of this tool have never been combined to measure quality of care at the end of life. In this research project, we will partner with care staff, decision makers, nursing home residents and their family members to study the modifiable symptoms and inappropriate care practices experienced by residents in Canadian nursing homes near the end of life. Together with our partners, we will determine which symptoms and practices are most distressing, and we will use RAI-MDS 2.0 outcomes to develop and evaluate robust ways to measure and monitor these symptoms and practices. This focus on end of life care in nursing homes makes this project unique and urgently needed. Strategies to reduce suffering and address problems of care quality and cost must be based on better knowledge. By developing a way to measure and monitor these quality problems, this project will significantly contribute to the development of such strategies.