Palliative Care Development in European Care Homes and Nursing Homes

Background: The provision of institutional long term care for older people varies across Europe reflecting different models of health care delivery. Care for dying residents requires integration of palliative care into current care work, but little is known internationally of the different ways in which palliative care is being implemented in the care home setting. \ud \ud Objectives: To identify and classify, using a new typology, the variety of different strategic, operational and organisational activities related to palliative care implementation in care homes across Europe. \ud \ud Design and methods: We undertook a mapping exercise in 29 European countries, using two methods of data collection: (1) a survey of country informants and (2) a review of data from publically available secondary data sources and published research. Through a descriptive and thematic analysis of the survey data we identified factors that contribute to the development and implementation of palliative care into care homes at different structural levels. From this data a typology of palliative care implementation for the care home sector was developed and applied to the countries surveyed. \ud \ud Results: We identified three levels of palliative care implementation in care homes: macro (national/regional policy, legislation, financial and regulatory drivers), meso (implementation activities such as education, tools/frameworks, service models and research) and micro (palliative care service delivery). This typology was applied to data collected from 29 European countries and demonstrates the diversity of palliative care implementation activity across Europe with respect to the scope, type of development and means of provision. We found that macro and meso factors at two levels shape palliative care implementation and provision in care homes at the micro organisational level. \ud \ud Conclusions: Implementation at the meso and micro level is supported by macro level engagement, but can happen with limited macro strategic drivers. Ensuring the delivery of consistent and high quality palliative care in care homes is supported by implementation activity at these three levels. Understanding where each country is in terms of activity at these three levels (macro, meso and micro) will allow strategic focus on future implementation work in each country.