134Palliative Care in Nursing Home Residents: Are we Doing Enough?

Nursing home residents (NHRs) have poor survival outcomes following hospitalisation. Palliative care interventions can improve quality of healthcare in this frail population. Our study aimed to examine the provision of palliative care for NHRs during the last 6 months of their life. Retrospective analysis of NHRs with unscheduled admissions to a tertiary teaching hospital, over a 12-month period in 2016. 567 NHRs had unscheduled admissions over this period. 31% (n = 176) died within 6 months of admission. 55% of deaths (n = 96) occurred in hospital. Of those who died in hospital, their mean time from admission to death was 9 days (1–93 days), with one third died within 48 hours of admission. 80 residents died in nursing homes within 6 months of admission. Their mean time from discharge to death was 61 days (1–173 days), with just over 40% died within the first month. Overall, 26.7% (n = 47) of deceased residents were seen by palliative care team (PCT). The majority (85%) of assessments occurred in hospital. Of those who died in hospital, 25% (n = 24) had palliative care interventions. They were referred an average of 3.6 days (0–17 days) prior to their death. 17% (n = 4) were referred on day of death. Of those who died in nursing homes, 20% (n = 16) were reviewed by PCT in hospital and the mean time from referral to death was 20 days (1–68 days). All bar one referrals were seen by PCT on the same day of referral. 16% (n = 13) of those who died in nursing homes had community palliative care interventions following discharge. 7 were referred directly by their GP, with the remaining referred by hospital based PCT. 30% (n = 24) had advance care planning documented in their transfer letters on discharge. Uptake of palliative care service among NHRs is poor with only 1 in 4 referred during the last 6 months of life. Interventions focusing on improved education and enhanced communication are required to address this deficiency of care in NHRs.