There is substantial anecdotal evidence within the nursing home field that too few residents receive effective palliative care at the end of life. In response to this problem, the California HealthCare Foundation sponsored a project by The HSM Group to study barriers to appropriate end-of-life palliative care in nursing homes, and potential approaches to reducing those barriers.

HSM organized focus groups to discuss end-of-life care with care providers and residents' families. It also engaged in a survey of facility policies and practices regarding end-of-life care and conducted interviews with experts in the field.

The HSM study explored a number of questions, including:

• Why do so few nursing home residents have effective advance health care directives?
• Why are nursing home residents often transferred to hospitals during the end-of-life period, and how many of these transfers are necessary?
• What aspects of the nursing home context constrain the delivery of palliative care at the end of residents' lives?

The study followed up on these questions by examining how the problems they highlight might be addressed and by whom. The issue brief, which summarizes the study's findings, is available under Document Downloads.