Abstract
BackgroundNursing homes are becoming more important for end-of-life care. Within the industrialised world, Germany is among the countries with the most end-of-life hospitalizations in nursing home residents. To improve end-of-life care, investigation in the status quo is required. The objective was to gain a better understanding of the perspectives of nursing home staff on the current situation of end-of-life care in Germany.MethodsA cross-sectional study was conducted as a postal survey among a random sample of 1069 German nursing homes in 2019. The survey was primarily addressed to nursing staff management. Data was analyzed using descriptive statistics. Staff was asked to rate different items regarding common practices and potential deficits of end-of-life care on a 5-point-Likert-scale. Estimations of the proportions of in-hospital deaths, residents with advance directives (AD), cases in which documented ADs were ignored, and most important measures for improvement of end-of-life care were requested.Results486 (45.5%) questionnaires were returned, mostly by nursing staff managers (64.7%) and nursing home directors (29.9%). 64.4% of the respondents rated end-of-life care rather good, the remainder rated it as rather bad. The prevalence of in-hospital death was estimated by the respondents at 31.5% (SD: 19.9). Approximately a third suggested that residents receive hospital treatments too frequently. Respondents estimated that 45.9% (SD: 21.6) of the residents held ADs and that 28.4% (SD: 26.8) of available ADs are not being considered. Increased staffing, better qualification, closer involvement of general practitioners and better availability of palliative care concepts were the most important measures for improvement.ConclusionsTogether with higher staffing, better availability and integration of palliative care concepts may well improve end-of-life care. Prerequisite for stronger ties between nursing home and palliative care is high-quality education of those involved in end-of-life care.
Highlights
Nursing homes are becoming more important for end-of-life care
The present study mainly focuses on aspects dealing with end-of-life care
Characteristics of the respondents and the nursing homes In total 486 questionnaires were included in the analysis
Summary
Nursing homes are becoming more important for end-of-life care. Germany is among the countries with the most end-of-life hospitalizations in nursing home residents. The objective was to gain a better understanding of the perspectives of nursing home staff on the current situation of end-of-life care in Germany. More than half of the nursing homes in Germany are run by non-profit organizations, approximately 40% by private for-profit organizations, and the remainder are in public ownership, usually run by municipalities [5]. With the demographic change continuing, the number of older (2020) 19:2 care-dependent people is estimated to increase up to 4.5 million by 2060 [6]. The demographic change is likely to negatively affect the availability of skilled nursing staff on the job market [7]
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