Caring for Nursing Home Residents Approaching the End of Life

May 8, 2012 — 1,634 views  
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The days and minutes leading up to a family member's death are the most trying times an individual experiences. According to statistics, 28 percent of elderly individuals pass away while residing in a nursing home. Experts anticipate this figure will increase to 40 percent by 2020. Sadly, the field of gerontology is growing at a rapid rate as more individuals require palliative care and end-of-life counseling. Due to this increase and the importance of psychological support for patients and family members, the National Association of Social Workers (NASW) and other professional groups have developed certification courses and standards for social workers who provide end-of-life counseling.

End-of-life care is a complex and emotionally difficult issue. Working with patients who are approaching the end of life requires an extreme level of care and understanding. Everyone deals with grief differently, and the matter is further complicated by religious, cultural and emotional beliefs. For these reasons, social workers who assist patients approaching this stage must guide families through the decision-making process while understanding and respecting their beliefs and conforming to legal, ethical and health care policies.

Standards for end-of-life care focus on helping individuals decide how their loved ones wish to spend their final months while recognizing that these goals change. Social workers must help family members weigh risks and benefits, set goals and provide resources in an interdisciplinary manner. A nursing home is one of the best places for individuals who require end-of-life care. Studies from the CDC show that 65 percent of nursing home residents had advance directives in place, which is more than twice the number of home healthcare patients who have living wills, do-not-resuscitate orders, power of attorney statements or health care proxies.

One Japanese study found that individuals who passed away in nursing homes lived longer, had fewer hospitalizations and were involved in more terminal care conferences. Very few people approaching the end of life can clearly express their wishes. Some patients express these ideas through family members, but 61 percent of individuals are unable to provide any information. In these situations, social workers must analyze fears, worries and personal beliefs while taking appropriate actions. Something as simple as providing family members with resources and completing anticipatory conferences are highly effective in guiding family members through the bereavement and grieving process while allaying fears. Although difficult, end-of-life education achieves the important goal of empowering patients and family members.