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Background The proportion of people dying in long-term care institutions is predicted to increase in future years. Establishing the costs associated with the provision of such care is important as it represents a potentially increasing burden. Aim This study describes the end of life healthcare costs for nursing home residents. The study also explores the effects of resident characteristics on costs, through regression modelling. Setting This study took place in south-east England. Participants Thirty-eight nursing care homes took part in the study, comprising 2444 individual residents. Methods Using a retrospective cohort design, end of life service use was recorded from residents’ nursing care home notes. In this study, end of life was defined as the last six months of life, or from time of residency if this was less than six months. Costs were calculated assuming a healthcare payer perspective. Results The total mean healthcare cost per resident was £3906. Hospital stays accounted for two-thirds (67%) of these costs. Fifty-six percent of these hospital stays occurred in the final month of life. Death in hospital vs. in the nursing care home was associated with an average increase in costs of £4223. Conclusions Death in hospital is costly, and is seldom identified as a preferred place of death. Therefore, interventions are needed which help nursing care home staff to identify when an individual is dying, and have the skill and confidence to make difficult decisions regarding care provision at the end of life. [ABSTRACT FROM AUTHOR]

Background: In the UK, implementation of the Gold Standards Framework in Care Homes (GSFCH) programme is being promoted to develop the quality of end-of-life care for frail older people living and dying in care homes. Advance care planning (ACP) discussions are an integral part of this. This study explored experiences of initiating and completing these discussions in homes undertaking the GSFCH. Methods: A qualitative descriptive study was carried out in three nursing care homes implementing the GSFCH programme. Following an ACP discussion, 28 semi-structured interviews were conducted with the resident, a family member, and the staff member who undertook the ACP. Content analysis was then conducted. Findings: Three main categories of findings emerged: understanding ACP, undertaking ACP discussions, and impact of and reactions to ACP discussions. Staff understanding of ACP varied, affecting the depth of their discussions. Documentation was either a useful prompt or limited the discussion, blocking opportunistic cues and encouraging a 'tick-box' exercise. Residents were open to ACP, although the way it was introduced could affect the results. Families were comforted that the resident's future care had been considered. Education was identified as being important, and role modelling ACP enabled a member of staff to develop their skills and confidence in it. Conclusions: Care home staff need to develop the knowledge, skills, and confidence to engage in discussions around end-of-life care. The assistance of a trained facilitator who role-models this process should be explored. [ABSTRACT FROM AUTHOR]

Background: The palliative care needs of older people residing in care homes are not always recognised. Approximately two-thirds of people in care homes have dementia. However, people with advanced dementia are not always recognised as having a terminal condition and, consequently, their end-of-life care needs are not well understood. The Gold Standards Framework in Care Homes (GSFCH) and the Liverpool Care Pathway for the Dying Patient (LCP) (care home version) are advocated to improve the quality of end-of-life care in care homes. However, evidence on the efficacy of such tools to improve outcomes or change practice is lacking. Aim: The aim of this research was to evaluate the impact on the quality of end-of-life care of the GSFCH and LCP in care homes with nursing. Methods: Qualitative interviews were conducted with 22 bereaved relatives/friends before, and 14 bereaved relatives/friends and six care home managers after, implementation of the GSFCH and LCP into seven care homes with nursing. Content analysis guided by the 7Cs of the GSFCH was conducted. Results: Care home staff changed their attitudes about dying. This enabled more informed end-of-life decision-making involving families/friends, staff and GPs. Findings suggest that improvements in care of the dying occurred following implementation of both tools. Conclusion: The GSFCH and LCP improve end-of-life care by influencing end-of-life culture, decision-making and practice. [ABSTRACT FROM AUTHOR]

Background: Several studies have highlighted the need for improvement in palliative care delivered to older people long-term care facilities. However, the available evidence on how to improve palliative care in these settings is weak, especially in Europe. We describe the protocol of the PACE trial aimed to 1) evaluate the effectiveness and cost-effectiveness of the ‘PACE Steps to Success’ palliative care intervention for older people in long-term care facilities, and 2) assess the implementation process and identify facilitators and barriers for implementation in different countries. Methods: We will conduct a multi-facility cluster randomised controlled trial in Belgium, Finland, Italy, the Netherlands, Poland, Switzerland and England. In total, 72 facilities will be randomized to receive the ‘Pace Steps to Success intervention’ or to ‘care as usual’. Primary outcome at resident level: quality of dying (CAD-EOLD); and at staff level: staff knowledge of palliative care (Palliative Care Survey). Secondary outcomes: resident’s quality of end-of-life care, staff self-efficacy, self-perceived educational needs, and opinions on palliative care. Economic outcomes: direct costs and quality-adjusted life years (QALYs). Measurements are performed at baseline and after the intervention. For the resident-level outcomes, facilities report all deaths of residents in and outside the facilities over a previous four-month period and structured questionnaires are sent to (1) the administrator, (2) staff member most involved in care (3) treating general practitioner, and (4) a relative. For the staff-level outcomes, all staff who are working in the facilities are asked to complete a structured questionnaire. A process evaluation will run alongside the effectiveness evaluation in the intervention group using the RE-AIM framework. Discussion: The lack of high quality trials in palliative care has been recognized throughout the field of palliative care research. This cross-national cluster RCT designed to evaluate the impact of the palliative care intervention for long-term care facilities ‘PACE Steps to Success’ in seven countries, will provide important evidence concerning the effectiveness as well as the preconditions for optimal implementation of palliative care in nursing homes, and this within different health care systems. Trial registration: The study is registered at www.isrctn.com – ISRCTN14741671 (FP7-HEALTH-2013-INNOVATION-1 603111) Registration date: July 30, 2015. [ABSTRACT FROM AUTHOR]

Background: The provision of quality end-of-life care is increasingly on the national agenda in many countries. In the United Kingdom, the Gold Standards Framework for Care Homes programme has been promoted as a national framework for improving end-of-life care. While its implementation is recommended, there are no national guidelines for facilitators to follow to undertake this role., Aim: It was hypothesised that action learning alongside high facilitation when implementing the Gold Standards Framework for Care Homes programme will result in a reduced proportion of hospital deaths for residents and improvement in the care home staff ability to facilitate good end-of-life care., Design: A cluster randomised controlled trial where 24 nursing homes received high facilitation to enable them to implement the Gold Standards Framework for Care Homes programme. The managers of 12 nursing homes additionally took part in action learning sets. A third group (14 nursing homes) received the 'standard' Gold Standards Framework for Care Homes facilitation available in their locality., Setting/participants: In total, 38 nursing homes providing care for frail older people, their deceased residents and their nurse managers., Results: A greater proportion of residents died in those nursing homes receiving high facilitation and action learning but not significantly so. There was a significant association between the level of facilitation and nursing homes completing the Gold Standards Framework for Care Homes programme through to accreditation. Year-on-year change occurred across all outcome measures., Conclusion: There is a danger that without national guidelines, facilitation of the Gold Standards Framework for Care Homes programme will vary and consequently so will its implementation. The nurse manager of a care home must be actively engaged when implementing the Gold Standards Framework for Care Homes programme., (© The Author(s) 2014.)