ATTITUDES TOWARD HOSPICE CARE

Abstract

We designed and pilot tested a survey to explore how nursing home physicians and hospice staff perceive hospice use in the nursing home. A convenience sample of nursing home, hospice, and hospital-affiliated personnel and physicians, primarily in Maryland, North Carolina, Oklahoma, Michigan, and California, were asked to complete a survey questionnaire regarding hospice care in nursing homes. The questionnaire addresses whether nursing homes provide the same end-of-life care as hospice services provide, whether there are perceived problems in communication or cooperation between hospices and nursing homes, and what, if anything, contributes to the effectiveness of hospices in nursing homes. Questions were primarily formulated for dichotomous agreement or disagreement, although two questions offered multiple response options. Differences in the responses were statistically analyzed using chi-square tests to compare responses by professional role. Written comments were transcribed and categorized. A total of 250 responses were obtained, of which 101 were from physicians, including 48 medical directors. The responses from the medical directors were similar to responses from hospice personnel and nursing home personnel. The respondents uniformly felt that hospice makes a difference, and the nursing home cannot do the same quality of care without hospice. All the professions who responded, whether nursing home medical directors with or without hospice affiliation, or hospice employees, shared this attitude. The respondents also agreed that there are still some issues with integrating hospice into nursing homes, especially with meshing the different cultures and getting good communication. We conclude from this pilot study that nursing home medical directors generally have positive attitudes towards hospice services in the nursing home that are very similar to the attitudes of hospice personnel. It is unlikely that medical directors are a major barrier to implementation of hospice services.