Exploring End‐of‐Life Care in Veterans Affairs Community Living Centers

Abstract

OBJECTIVES: To compare quality of end-of-life (EOL) care indicators and family evaluation of care in community living centers (CLCs) with that of EOL care in acute, intensive, and hospice and palliative care units. DESIGN: Retrospective chart review and survey with next of kin of recently deceased inpatients. SETTING: Inpatient Veterans Affairs (VA) Medical Centers (N = 145), including 132 CLCs, across the United States. PARTICIPANTS: The chart review included all individuals who died in VA inpatient units (n = 57,397). Family survey results included data for 33,497 veterans. MEASUREMENTS: Indicators of optimal EOL care: palliative consultation in the last 90 days of life, contact with a chaplain, family contact with a chaplain, and emotional support given to family after death. The main outcome was a single Bereaved Family Survey item in which respondents provided a global evaluation of quality of EOL care (excellent to very good, good, fair to poor). RESULTS: Family evaluations of overall EOL care and quality of EOL care indicators for veterans who died in CLCs were better than those of veterans dying in acute or intensive care units but worse than those dying in hospice or palliative care units. CONCLUSION: Care in CLCs can be enhanced through the integration of palliative care practices. Future research should identify critical elements of enhancing EOL care in nursing homes.