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Distributed December 12, 2003
Contact Cynthia Ferguson

Brown receives grant to expand use of hospice in nursing homes

A one-year project funded with a grant from The Robert Wood Johnson Foundation and headed by Brown University Assistant Professor Susan Miller will identify and examine nursing homes where use of hospice is widespread. The project will culminate in a “best practices” publication intended to help nursing homes and hospices collaborate more easily.

PROVIDENCE, R.I. — Studies show that hospice enhances end-of-life care in nursing homes, yet only a fraction of elderly who are eligible for these services ever receive them. Medicare has offered hospice as a nursing home benefit since 1985 but just 8 percent of all dying residents currently receive it.

Most nursing homes remain a long way from fully embracing hospice care in their programs, but some, in fact, have integrated it with great success. These are the organizations Susan Miller, assistant professor of community health at Brown University, will look at in a one-year project funded with a grant from The Robert Wood Johnson Foundation.

Miller and members of an advisory committee will identify five nursing homes across the country where hospice care is routinely provided to terminally ill residents. They will then visit these sites to determine exactly how and why these institutions have collaborated with hospice so successfully when others continue to find the collaboration so difficult.

Most nursing homes offer compassionate, competent care, but chronic staff shortages, high staff turnover and inadequate reimbursement often adversely affect the quality of care they can provide. Studies find that nursing home residents too often endure unnecessary pain in the final stages of a terminal disease, and many suffer from a lack of emotional support. Hospice brings expertise in palliative care and pain management into the nursing home, as well as an extra pair of hands.

In past research, Miller has identified some of the issues hindering the collaboration of nursing homes and hospice. Some financial disincentives exist with federal and state reimbursements, and problems often surface when two organizations – the nursing home and the hospice provider – try to merge their different philosophies and administrative structures.

After examining nursing homes that have removed or mitigated these obstacles, Miller and her team will publish a manual outlining practices that work. The publication – Best Practices for Nursing Home End-of-Life Care – will include case studies of the five nursing homes visited, as well as a review of existing literature and available resources for improving end-of-life care. This information will also be accessible on a web site, which Miller expects to have up and running by the spring.

“The ultimate goal of this project,” Miller says, “is to improve the quality of end-of-life care by increasing access to hospice care in nursing homes.” She also hopes to encourage nursing homes to refer residents to hospice in earlier stages of a terminal illness. Currently, one out of every four Americans dies in a nursing home, up from one in five just a decade ago.

The Robert Wood Johnson Foundation awarded the Brown University Medical School $199,220 to cover the cost of this one-year project. Among those working with Miller on the project are: Vincent Mor, professor of medical science at Brown; Joan Teno, M.D., associate professor of community health at Brown; and two independent consultants, Kathy Egan and Cherry Meier.


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