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Although the culture change movement has sought to transform residential care facilities from warehouses of death into homes for living, there is growing recognition of the need to address dying within these settings. Drawing on data from an international and interdisciplinary study, this paper explores the state of end-of-life care in residential care facilities, identifying barriers to the provision of compassionate care for the dying, as well as promising practices and areas for future inquiry. Interviews with staff and researcher observations at 20 nursing homes in Canada, Germany, Norway, Sweden, the United States, and the United Kingdom were analyzed. Six themes were identified: the growing need for end-of-life care; the challenge of identifying a dying phase; the importance of open communication about death; the need to address bereavement of both families and staff; the need for additional training and resources; and the inadequacy of current models of care. Taken together, these findings suggest that dying intensifies the need for relational care, a type of care residential care facilities have been struggling to provide. However, while demands increase, there are also opportunities. We conclude with a reflection on the potential that the blurred boundaries between living and dying hold for experimentation in long-term residential care with visions of life and health that can include death. [ABSTRACT FROM AUTHOR]

Compared to a decade ago, long-term care residents are likely to be older, frailer, more functionally impaired, more medically complex, and closer to the end of life. Because of this, residents are also less likely to benefit from and more likely to be harmed by the same drugs and routine medical interventions that may have worked well for them earlier in life. Family physicians are well positioned to play a key role in navigating the tensions between life extension, rehabilitation, symptom management, and palliation. Unfortunately, in many jurisdictions, despite more than a decade of primary care reform, family physicians are not attracted to working in long-term residential care (LTRC). The proportion of those working in LTRC has been declining over time, and there is no mandatory training of family physicians in LTRC work. This article reviews the influence of Canadian primary care policy related to the physician role in LTRC facilities and describes a number of promising practices across Canadian provinces to engage them in LTRC teamwork. [ABSTRACT FROM AUTHOR]