Journal of the American Medical Directors Association · 2026
Opportunities for Improving End-of-Life Care for Veterans Receiving Hospice in Community Nursing Homes.
СтатьяПоддержка исследования: вне правительства СШАНазвание и аннотация: Перевод в очереди
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Kutney-Lee Ann, Griffin-Nelson Hilary, Smith Dawn, Giannitrapani Karleen, Carpenter Joan G, Sullivan Donald R, Levy Cari, McKenzie Jennifer, Pendergast Jacquelyn, Wachterman Melissa W
Аннотация
OBJECTIVES: The Department of Veterans Affairs (VA) has demonstrated a longstanding commitment to ensuring that veterans receive high-quality end-of-life care, including hospice services. Despite its growing use, evidence suggests that the quality of end-of-life care is lower among veterans receiving hospice in VA-contracted community nursing homes (CNHs) compared with VA inpatient settings. The objective of this analysis was to explore the perspectives of bereaved family members of veterans who received CNH-based hospice care to identify opportunities for improvement.
DESIGN: Qualitative analysis of open-ended survey responses.
SETTING AND PARTICIPANTS: Next of kin of a national cohort of 450 veterans who died between October 2022 and September 2023 while receiving VA-contracted hospice care in CNHs who responded to at least one of the open-ended items on VA's Bereaved Family Survey.
METHODS: Using conventional content analysis of Bereaved Family Survey responses, themes were collaboratively identified within inductively identified, overarching domains. Direct recommendations from respondents were also identified.
RESULTS: We identified 6 overarching domains: (1) CNH staff interactions reflected comments related to staff demeanor, communication, and attentiveness; (2) VA's role in CNH-based hospice care encompassed themes related to available options for hospice care, CNH screening and oversight, VA involvement, and benefits; (3) hospice care delivery and coordination included comments related to hospice team communication and care delivery, as well as coordination of care with the CNH; (4) CNH resources focused on CNH staffing levels, environmental conditions, and available services; (5) attention to personal care needs by CNH staff included themes related to food and hydration, skin care, and toileting; and (6) symptom management focused on how pain and other symptoms were managed by staff.
CONCLUSIONS AND IMPLICATIONS: Efforts are needed to improve care coordination, role clarity, and VA oversight to optimize the quality of the end-of-life care experience for veterans who receive CNH-based hospice care.
DESIGN: Qualitative analysis of open-ended survey responses.
SETTING AND PARTICIPANTS: Next of kin of a national cohort of 450 veterans who died between October 2022 and September 2023 while receiving VA-contracted hospice care in CNHs who responded to at least one of the open-ended items on VA's Bereaved Family Survey.
METHODS: Using conventional content analysis of Bereaved Family Survey responses, themes were collaboratively identified within inductively identified, overarching domains. Direct recommendations from respondents were also identified.
RESULTS: We identified 6 overarching domains: (1) CNH staff interactions reflected comments related to staff demeanor, communication, and attentiveness; (2) VA's role in CNH-based hospice care encompassed themes related to available options for hospice care, CNH screening and oversight, VA involvement, and benefits; (3) hospice care delivery and coordination included comments related to hospice team communication and care delivery, as well as coordination of care with the CNH; (4) CNH resources focused on CNH staffing levels, environmental conditions, and available services; (5) attention to personal care needs by CNH staff included themes related to food and hydration, skin care, and toileting; and (6) symptom management focused on how pain and other symptoms were managed by staff.
CONCLUSIONS AND IMPLICATIONS: Efforts are needed to improve care coordination, role clarity, and VA oversight to optimize the quality of the end-of-life care experience for veterans who receive CNH-based hospice care.