Integrating a Palliative Approach to Care in Long-Term Care: A Comparative Case Study of Two Provinces

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Hubley, Emily V.
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Mount Saint Vincent University
Aging in place initiatives have contributed to a shift in long-term care (LTC) where residents are now entering at an older age, have greater health complexities, and have a shorter length of stay. Veering from the traditional biomedical approach to address the changing needs, integrating a palliative approach to care in LTC aims to provide comfort and improve the quality of life for residents and their families. A comparative case study design was used to understand how two Canadian jurisdictions, British Columbia (BC) and Nova Scotia (NS), integrate a palliative approach into LTC policy and how they differ. An iterative process of data collection and analysis was used wherein a total of 29 LTC-specific regulatory policies (16 in BC and 13 in NS) were examined using a qualitative content analysis method. Analysis was guided by an innovative framework of 10 domains developed specifically for this analysis (adapted from the Canadian Hospice Palliative Care Association and Accreditation Canada). The 10 domains encompass a palliative approach to care and are as follows: care delivery; care planning; communication; end-of-life care/management; loss/grief/bereavement; physical health; practical activities; psychological; social; and spiritual and cultural. After all policies had been coded as part of the content analysis, thematic analysis was used within each domain to uncover the specific themes related to a palliative approach to care and how they were supported in policy and similar to or different in each jurisdiction. Analysis revealed highly similar findings across both BC and NS in terms of the recurrence of domains that were supported. In both jurisdictions, communication, physical health, social, and care delivery were among the most coded and end-of-life care/management and loss/grief/bereavement were the least coded. Promising approaches were identified around open communication among the interdisciplinary team, processes to discuss and document an individual’s goals of care and advance care planning, health assessments and safety, and encouraging social relationships and activities were identified. Although many domains of a palliative approach to care are highly reflected in LTC policy, gaps are identified around end-of-life care and providing supports post-death in loss, grief, and bereavement. In conclusion, policy must go beyond the here and now and further support the final stages of life and post-death care to improve residents and families’ experiences at the end of life.
Aging, long term care, palliative care