• J Pain Symptom Manage · Mar 2019

    The effect of residential aged care size, ownership model and multi-chain affiliation on resident comfort and symptom management at the end of life.

    • Rosemary Frey, Deborah Balmer, Jackie Robinson, Merryn Gott, and Michal Boyd.
    • School of Nursing, Faculty of Medical and Health Sciences University of Auckland, Auckland, New Zealand. Electronic address: r.frey@auckland.ac.nz.
    • J Pain Symptom Manage. 2019 Mar 1; 57 (3): 545-555.e1.

    ContextIn most resource-rich countries, a large and growing proportion of older adults with complex needs will die while in a residential aged care (RAC) facility.ObjectivesThis study describes the impact of facility size (small/large), ownership model (profit/nonprofit) and provider (independent/chain) on resident comfort, and symptom management as reported by RAC staff.MethodsThis retrospective "after-death" study collected decedent resident data from a subsample of 51 hospital-level RAC facilities in New Zealand. Symptom Management at the End-of-Life in Dementia and Comfort Assessment in Dying at End of life with Dementia (SM-EOLD and CAD-EOLD, respectively) scales were used by RAC staff who were closely associated with 217 deceased residents. Data collection occurred from January 2016 to February 2017.ResultsResults indicated that residents of large, nonprofit facilities experienced greater comfort at the end of life (CAD-EOLD) as indicated by a higher mean score of 37.21 (SD = 4.85, 95% CI = 34.4, 40.0) than residents of small for-profit facilities who recorded a lower mean score of 31.56 (SD = 6.20, 95% CI = 29.6, 33.4). There was also evidence of better symptom management for residents of chain facilities, with a higher mean score for symptom management (SM-EOLD total score) recorded for residents of chain facilities (mean = 28.07, SD = 7.64, 95% CI = 26.47, 29.66) than the mean score for independent facilities (mean = 23.93, SD = 8.72, 95% CI = 21.65, 26.20).ConclusionFindings suggest that there are differences in the quality of end-of-life care given in RAC based on size, ownership model, and chain affiliation.Copyright © 2018 American Academy of Hospice and Palliative Medicine. Published by Elsevier Inc. All rights reserved.

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