Palliative care in long-term care: A multi-methods approach to assessing quality
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Date
2007-09
Authors
McEvenue, Shannon
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Abstract
Long-term care facilities provide care for chronic illness, usually until death yet little research is directed at the provision of palliative are in these settings. With the population in Canada aging an increasing number of people will require long-term care services including hospice palliative care. There is a need for empirical knowledge that will contribute to policy development, implementation, and evaluation in this increasingly important area of health care service delivery. The main objective of this research was to define high quality hospice palliative care service delivery through the exploration of approaches taken to provide palliative care at Veterans Affairs Canada (VAC) facilities across Canada.
This study was guided by the Canadian Hospice Palliative Care Association’s (CHPCA) (2002) A Model to Guide Hospice Palliative Care. Five facilities across Canada were selected for their high quality of palliative care programming as defined by representatives from VAC. Data collection included written policies submitted by participating facilities, interviews with two key informants from each facility, and field observations of three front-line care workers at one facility. Analysis involved coding of data using QSR NUD*IST software. A normative policy analysis of the coded data was conducted using the CHPCA model as a policy framework.
Results indicated that the components of the studied policies at each facility were similar and were, for the most part, in keeping with the domains of care included in the CHPCA model. Each of the programs were well resourced. Approaches to program implementation were individualized based on facility needs. Barriers to care included
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pain assessment of residents with dementia, interpersonal conflict, and human resource deficiencies during expected deaths and health crises. A lack of recognition of the emotional toll paid by front-line workers was also determined to be a barrier to quality care. Enhancers included a wide range of service availability, knowledgeable front-line care workers, and a high capacity for maintaining continuity of care through effective communication, interpersonal relations, and team approach to care.
Findings suggest that the principles of palliative care were evident in the programs provided by participating facilities and their experiences may enable other facilities to introduce palliative care. The hospice palliative care services available at the participating facilities provided a quality of life for residents that effectively demonstrated a need for improved funding and services in this area of care at long-term care facilities across Canada. Although participating facilities were well funded, further resources needed to be directed towards providing emotional support and bereavement care for both families and care providers.
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Keywords
Hospice care , Long-term care facilities , Evaluation , Canada , Palliative treatment