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Geriatr Nurs. 2017 Nov - Dec;38(6):531-536. doi: 10.1016/j.gerinurse.2017.03.016. Epub 2017 Apr 28.

Nursing home care trajectories for older adults following in-hospital palliative care consultation.

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University of Utah College of Nursing, 10 South 2000 East, Salt Lake City, UT 84112, USA; Corporal Michael J. Crescenz VA Medical Center - Philadelphia, 3900 Woodland Avenue, Annex Suite 203, Philadelphia, PA 19104, USA. Electronic address:
Hartford Center of Gerontological Nursing Excellence at OHSU, Oregon Health and Science, University School of Nursing, Mail Code: SN-6S, 3455 SW US Veterans Hospital Road, Portland, OR 97239, USA.
Corporal Michael J. Crescenz VA Medical Center - Philadelphia, 3900 Woodland Avenue, Annex Suite 203, Philadelphia, PA 19104, USA; University of Pennsylvania School of Nursing, Philadelphia, PA 19104, USA.


Palliative care consultation (PCC) during hospitalization is increasingly common for older adults with life-limiting illness discharged to nursing homes. The objective of this qualitative descriptive study was to describe the care trajectories and experiences of older adults admitted to a nursing home following a PCC during hospitalization. Twelve English-speaking adults, mean age 80 years, who received a hospital PCC and discharge to a nursing home without hospice. Data were collected from medical records at five time points from hospital discharge to 100 days after nursing home admission and care trajectories were mapped. Interviews (n = 15) with participants and surrogates were combined with each participant's medical record data. Content analysis was employed on the combined dataset. All PCC referrals were for goals of care conversations during which the PCC team discussed poor prognosis. All participants were admitted to a nursing home under the Medicare skilled nursing facility benefit. Seven were rehospitalized; six of the 12 died within 6 weeks of initial nursing home admission. The two care trajectories were Focus on Rehabilitative Care and Comfort Care Continuity. There was a heavy emphasis on recovering functional status through rehabilitation and skilled nursing care, despite considerable symptom burden and poor prognosis. Regardless of PCC with recommendations for palliative interventions, frail older adults with limited life expectancy and their family caregivers often perceive that rehabilitation will improve physical function. This perception may contribute to inappropriate, ineffective care. More emphasis is needed to coordinate care between PCC recommendations and post-acute care.


Hospitalization; Nursing homes; Palliative care; Patient care planning; Patient discharge; Skilled nursing facilities

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