Miller Susan C
Professor of Health Services, Practice and Policy (Research) at the Center for Gerontology and Healthcare Research, Brown University School of Public Health.
R I Med J (2013). 2014 Apr 1;98(4):26-9.
The use of hospice care in nursing homes (NHs) has grown exponentially, but an increasing concern is the lack of access to resident and family-centered palliative care when residents do not elect hospice, and in time periods prior to election. This concern is amplified by the high magnitude of palliative care needs present for NH residents (and their families) when the NH will be their final residence; and, it is amplified because of short hospice stays, half of which are 22 days or less. This manuscript describes the use of the Medicare hospice care in NHs and discusses the policy, staff and physician barriers to timely hospice referral. It also describes the challenges NHs face in expanding residents' access to palliative care. Opportunities and approaches for increasing palliative care expertise and practice in NHs are presented.
养老院（NHs）中临终关怀服务的使用呈指数级增长，但越来越令人担忧的是，当居民未选择临终关怀服务时，以及在选择之前的时间段内，缺乏以居民和家庭为中心的姑息治疗。当养老院将成为居民的最终住所时，养老院居民（及其家人）对姑息治疗的高需求加剧了这一担忧；此外，由于临终关怀服务停留时间短，其中一半停留时间为22天或更短，这一担忧也被放大了。本文描述了养老院中医疗保险临终关怀服务的使用情况，并讨论了及时转诊临终关怀服务的政策、工作人员和医生障碍。它还描述了养老院在扩大居民获得姑息治疗机会方面面临的挑战。文中还介绍了在养老院增加姑息治疗专业知识和实践的机会及方法。
