Defining a Good Death for Residents in Long-term Care

Each day 1000 older adults die in nursing homes and another 500 in residential care/assisted living facilities. In addition, 30% of Medicare deaths in hospitals are recent transfers from long-term care, indicating that long-term care facilities are a major provider of end-of-life care for older adults. Yet, end of life care in these settings is largely unexamined. One reason for this omission is the challenging nature of the work as described in the introduction to this dissertation. However, the dissertation addresses those challenges and gives voice to the needs of residents who die in these settings through three papers based on the input of residents, bereaved family members, and staff caregivers. The first paper, Dying in Long-Term Care: Insights from Residents, Family Members and Staff, is based on ten focus groups in which participants were asked to describe a good death. They The second paper, Defining a Good Death: Family Members Speak, describes family responses to two open-ended questions regarding what was best and what could have been done better in the last month of the resident's life. The third paper, Measuring the Quality of Dying in Long- Term Care, introduces a new measure, of the Quality of Dying in Long-term Care (QODLTC), to be used for future research in these settings. Each paper makes a significant contribution to the literature, both by describing what is done well and where improvements can be made