Manuscripts Not Based on Original Research

• 35. Berger, A. Palliative Care in Long-Term-Care Facilities--- A Comprehensive Model. Journal of the American Geriatrics Society; 2001; 49:1570-1571. Annotation This editorial addresses the variation in the quality of care, especially in nursing homes. According to the Agency for Health Care Policy and Research, pain in the elderly often goes untreated in nursing homes because of disbeliefs about pain sensitivity, tolerance and use of opioids. This insensitivity to pain may be cause for sighting mismanagement and putting this elder population at risk. As a result the palliative care module was developed and will be added to the Minimum Data Set in nursing homes. The authors believe not only that hospice has a role at the end of life in long term care facilities but also that palliative care throughout the disease trajectory needs to be the goal. [Pub Med]   
• 36. Blevens, D; Deason-Howell, LM. End-of-Life Care in Nursing Homes: The Interface of Policy, Research, and Practice. Behavioral Sciences and the Law; 2002; 20:271-286. Annotation This paper considers how chronically ill older adults receive palliative care through hospice as a result of public policy. It follows the Bronfenbrenner’s ecological model, which analyses at the system level how various factors (including the influence of hospice on nursing home care from the perspective of the individual, the family and staff, the nursing home industry, and public policy) to understand current end-of-life care for nursing home residents. It concludes that multiple factors--race, ethnicity, care provider attitude, availability, and proprietary status of nursing home--all influence who elects to receive hospice care. The paper describes how public policy can effect and be informed by an ecological analysis of end-of-life care in a nursing home. [Pub Med]   
• 37. Cranmer, KW. Hospice Care in Long-Term Care Facilities: A Gerontologist’s Viewpoint. Nursing Home Medicine; 1996; 4:219-222. Annotation This article discusses the use of hospice/palliative care, rehabilitative care, and care of coexisting illness to treat the three most common conditions found in nursing homes: dementia, malnutrition and pressure sores. According to the author, there are three objectives for hospice care in the nursing home: to enhance services to the terminally ill, to meet the needs of the dying patient, and to increase the skills of hospice and the nursing home staff.  
• 38. Cranmer, KW. Hospice Defined: Benefits, Problems and Regulatory Conflicts. Nursing Home Medicine; 1997; 5:230-237. Annotation This article discusses whether or not hospice should totally separate from the nursing home. Currently, hospice remains under Title 18 regulation as a home health service, whereas nursing homes are under Title 19. The article goes on to discuss the role of the medical director in resolving the conflicts between hospice and the nursing home. The author provides a set of guidelines to be used when the patient enters the nursing home.  
• 39. Hanson, LC. Creating Excellent Palliative Care in Nursing Homes. Palliative Medicine; 2003; 6:1:7-9. Annotation In this editorial, the author reviews three fundamental lessons in an effort to bring palliative care to nursing homes: education improves quality, hospice is available but not always accepted, and innovative programs show promise. The article argues that improved quality comes from education with feedback of performance data to motivate and effect change. Quality is also improved by increasing hospice care, pain assessment, and advanced care planning documentation. If hospice is to become the primary provider of palliative care in nursing homes, then regulatory, reimbursement and attitudinal barriers must be removed. Palliative care in nursing homes ranges from a mere marketing tool to truly innovative care. Evaluation measures need to be creative enough to reflect the human impact of palliative care. [Pub Med]   
• 40. Keay, TJ; Schonwetter, RS. The Case for Hospice Care in Long-Term Care Environments. Clinics in Geriatric Medicine; 2000; 16:2:211-223. Annotation A current view of the role of hospice care in long-term care and how it affects end-of-life care is reviewed. The authors discuss nursing homes as a setting and the palliative care needs of nursing home residents. Barriers to hospice delivery, such as the free-reign environment of hospice compared to the regulatory atmosphere of nursing homes and the financing of hospice care in nursing homes, are discussed. The authors also discuss opportunities for improving end-of-life care and ethical issues, arguing that death should not be made too readily available. [Pub Med]   
• 41. Keay, TJ; Schonwetter, RS. Hospice Care in the Nursing Home. American Family Physician; 1998; 57:3:491-494. Annotation This is an informational piece describing the Medicare Hospice Benefit. Hospice eligibility, services, current challenges, and physician responsibility are discussed. [Pub Med]   
• 42. Leland, J. The Nursing Home Medicare Hospice Benefit. Nursing Home Economics; 1996; 3:2:8-13. Annotation The author discusses how hospice care in nursing homes provides residents in need of care with benefits, including pain and symptom management as well as social, emotional, personal and spiritual support. These benefits to residents, in turn, benefit the nursing home in terms of increased occupancy, staff education, and good public relations. The article outlines models for reimbursement options combining Medicare benefits with either Medicaid or private pay for hospice care patients in nursing homes. [Pub Med]
• 43. Miller, SC; Mor, V. The Role of Hospice Care in the Nursing Home Setting. Palliative Medicine; 2002; 5:2:271- 277. Annotation The authors argue that the provision of Medicare hospice in nursing homes would appear to be an equitable use of Medicare expenditures as well as a valid investment in improving the quality of life for dying nursing home residents. Currently, however, the availability of hospice care in nursing homes differs across facilities and geographic areas. An optimal model for care of the terminally ill in nursing homes would equitably provide high quality terminal care and support to nursing home residents and their families while not increasing cost of care. [Pub Med]
• 44. Rochon, T; Heller, KS. A Nurse Practitioner Palliative Care Consult Service for Nursing Homes, Interview with Therese Rochon. Innovations in End-of-Life Care; 2002; 4:2:1-10. Annotation This interview begins with the steps taken to create a palliative care consultation program in Rhode Island for nursing home residents who were not eligible for Medicare hospice benefits. In addition, the role of the nurse practitioner, how palliative care can be brought into the nursing home, and how the program could be marketed and received are reviewed. The authors discuss the scope of the consulting services, defining palliative care as an interdisciplinary, holistic approach. They include case studies. The main target of the palliative care consultation program is the nursing home resident, but it also involves family members and staff. The interview covers referrals, financing, challenges, barriers, and resistance from nurses. It describes a direct model of care, advanced planning, family support as the patient declines, and evaluating success. Advice on how to start a program and how to extend palliative care to assisted living is addressed. 
• 45. Schonwetter, RS. Care of the Dying Patient. Care of the Terminally Ill Patient. Clinics in Geriatric Medicine; 1996; 12:2:253-265. Annotation This thesis first discusses the dilemmas faced by physicians caring for the elderly dying patient and then goes on to give a brief summary of the history of hospice. It includes demographics, cancer, philosophy, the interdisciplinary team, the need in the 1990s, national and international organizations and references. [Pub Med]
• 46. Watt, K. Hospices Within Nursing Homes: Should a Long Term Care Facility Wear Both Hats? A Commentary. American Journal of Hospice and Palliative Care; 1997; March/April: 63-65. Annotation This is a commentary by a family physician, who is the medical director of both a hospice and a nursing home, about the changes he has observed since the inception of hospice in nursing homes in 1983. At first hospice was unwelcome, but through education, many nursing home administrators are now realizing the marked benefits of having hospice present. According to the author, benefits include more skilled nursing visits, education for symptom control, and the fact that hospice activity insulates the nursing care facility from review teams when treating difficult patients by identifying those patients’ symptoms as part of the normal dying process rather than neglect. Hospice also enhances personal care, decreases complications, performs clinical assessment, and provides family comfort. As shorter hospital stays increase, so does the care provided by the nursing home. The author feels that caution needs to be considered as nursing homes begin to have their own hospices with the bottom line always in the forefront. He concludes that it is in the best interest of the patient that nursing homes and hospices remain separate entities with the current checks and balances in place. [Pub Med]  
• 47. Zerzan, J; Stearns, S; Hanson, L. Access to Palliative Care and Hospice in Nursing Homes. Journal of the American Medical Association; 2000; 248:19:2489-2494 (Special Comm). Annotation According to this response letter, current health policy discourages use of palliative care and hospice care for dying nursing home residents. Hospice care in nursing homes expanded from 7.7% in 1989 to 17% in 1995, while 70% of nursing homes have no hospice patients. Medicare covers only 65% of hospice care with restrictions and need for contractual agreements with nursing homes. Nursing home staff may see hospice as interfering with or duplicating their work or as another cause of criticism. Access to palliative care in nursing homes needs to be improved. The letter suggests several strategies which would enhance access to palliative care services in nursing homes by changing health policy and reimbursement. [Pub Med]