School
of Nursing
Funded Research
Projects: Aging and Elder Care
End of
Life Care in Assisted Living Facilities
Principal Investigator:
Juliana Cartwright
Abstract:
The purpose of this
study is to address the absence of descriptive knowledge about end-of-life
(EOL) care in the fastest growing, yet understudied, congregate residential
setting for frail older adults, assisted living facilities (ALF). Nationally
it is estimated that death accounts for 28% of the annual turnover in
ALF residents. Increasingly, dying ALF residents are enrolled in hospice
programs. Despite projections that ALFs will surpass nursing homes in
occupancy within several years, and estimates that the current national
population of 1 million ALF residents will double by 2020, there is limited
information on EOL care and hospice involvement in ALFs. Specifically,
this study will examine the perspectives of ALF staff and hospice nurses
on: 1) how EOL care is provided for ALF residents and 2) facilitators
and barriers to EOL care in ALFs. It addresses the National Institutes
of Health initiative "Research on Care at the End-of-Life" (RFA-NR-99-004,
1/20/99) and the Institute of Medicine's call for research on EOL care
that informs both how and where people die. A qualitative descriptive
design will be used. Face-to-face semi-structured interviews will be conducted
with a purposeful sampling of up to 36 ALF and hospice nurses in both
rural and urban sites in Oregon. In addition, documents used in EOL care
in ALFs will also be analyzed (e.g., flow sheets, protocols). Qualitative
content analysis will include the following components: open coding of
text data, constant comparative analysis of text data and documents, negative
case analysis, theoretical memos, and document trails. Key characteristics
of the care activities, similarities and differences in how the activities
are performed, and related challenges and barriers will be identified.
The end product of this study will be a detailed description of how EOL
care happens for ALF residents, from the perspectives of the staffs that
provide or supervise this care. The findings in combination with the PIs
earlier findings from dying residents and their families will be the basis
for developing and testing a model intervention aimed at improving EOL
care in ALFs in a subsequent R01 study.
Dates of Project:
9/30/2004 – 8/31/2006
Funding Agency: National Institute of Nursing Research
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