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1. Describe the palliative care needs among people with ADRD versus non ADRD during post-acute skilled nursing facility care in nursing homes. 2. Discuss how universal palliative care screening for people with ADRD may not reveal all unique palliative care needs. In this clinical trial of a palliative care intervention, participants both with and without dementia had a moderate level of palliative care needs, however individual differences may exist and require additional identification for what elements of palliative care are most beneficial. Seriously ill older adults, including those living with Alzheimer's Disease and Related Dementias (ADRD), often receive disease-focused rehabilitative care in post-acute skilled nursing facilities (SNF) with little consideration for potential palliative care (PC) needs. To compare the clinical characteristics and PC needs of people with ADRD versus those without ADRD on admission to SNF care. During a pilot pragmatic clinical trial of a palliative care intervention, we recruited newly admitted SNF patients with advanced serious illness (dementia, cancer, organ failure, and multiple chronic conditions) from 12 nursing homes (NHs) in the MidAtlantic US. We collected baseline demographics and clinical characteristics to calculate Charlson Comorbidity Index (CCI) scores and measured PC needs (e.g., physical/psychosocial symptoms, support/information requests) using the Palliative Outcome Scale Version 2 (range 0-40). Of 45 participants, 12(27%) had ADRD. Majority of participants with ADRD and without ADRD were female, (67% and 79% respectively), and similar in terms of age (mean=87 and 86, respectively) and race (100% and 97% White, respectively). However, 92% of participants with ADRD compared to 31% without ADRD were unable to make their own decisions. Participants with ADRD had longer estimated survival and somewhat less co-morbid illness than those without ADRD (CCI score 6 vs 7, p=0.09), but the difference was not significant. PC need scores did not differ between participants with ADRD (Mean=10.29, SD=5.38) and without ADRD (Mean=8.49, SD=4.69; p=.28), and the effect size was small (Cohen's d=0.37). Among individuals with ADRD, 50% reported depression, 64% reported experiencing pain, and 67% expressed the need for more information. During SNF care, people with and without ADRD had moderate PC needs. Regardless of ADRD diagnosis, older adults with serious illness admitted to SNFs may benefit from universal screening for PC. Future research should focus on identifying individual resident illness-related needs to determine most beneficial elements of PC. [ABSTRACT FROM AUTHOR]

1. Describe gaps in five-star quality rating system in measuring nursing home end-of-life care quality. 2. Identify two areas for improvement and/or active monitoring in the end-of-life care experience using the five-star quality rating system. In a cohort of 4,637 Veterans who died in a Department of Veterans Affairs nursing home there was no significant relationship between nursing home star ratings and bereaved family evaluations of end-of-life care. Findings suggest that nursing homes star rating systems do not measure the quality of end-of-life care. In Veterans Health Administration (VA)-operated nursing homes, known as Community Living Centers (CLCs), approximately one-third of residents die during their stay. Thus, commonly used five-star quality rating systems, such VA CLC Compare, should reflect quality of end-of-life (EOL) care; however, the relationship between CLC Star Ratings and EOL care quality is unknown. To examine associations between VA CLC Compare star ratings and quality of EOL care as measured by VA's Bereaved Family Survey (BFS). This retrospective observational study examined all Veterans who died in a CLC from October 2018 - September 2019 whose next-of-kin completed a BFS. CLC Star Ratings were based on performance in three domains: On-site Survey, Staffing, and Quality Measures. Primary outcome: BFS global rating item. Secondary outcomes: BFS factors of Respectful Care and Communication, Emotional and Spiritual Support, and Death Benefits; and individual BFS items related to management of pain and post-traumatic stress symptoms. Of the 4,637 Veterans in the sample, the mean age was 79 years; 4507 (97%) were male; and 3536 (76%) were non-Hispanic white. Differences in the BFS global rating at the facility-level (i.e., the BFS Performance Measure) by CLC star rating were small to none and not statistically significant. There was no significant relationship between a higher CLC Overall Star Rating and odds of an "excellent" BFS global rating (adjusted odds ratio 1.02; 95% CI 0.94-1.11; p=0.60). Similarly, no statistically significant relationships were observed between a higher CLC Overall Star Rating and scores on the BFS factors and symptom management items. Our findings suggest that the current CLC star rating system is not sufficient to assess the quality of EOL care. Our findings underscore the need for BFS scores or a comparative EOL quality of care measure to be integrated into five-star quality rating systems. Communication and prognostication/Interdisciplinary Teamwork/Professionalism [ABSTRACT FROM AUTHOR]