Palliative Care in Assisted Living and Care Homes: A Multi-National Meta-Synthesis and Policy Analysis (GP140)

Outcomes 1. Participants will gain an understanding of the key challenges and opportunities in providing palliative care within assisted living and care home settings for older adults. 2. Participants will be able to identify and analyze the factors influencing palliative care in residential care facilities and make informed recommendations for quality improvement. Key Message Older adults in Assisted Living/Care Home facilities have unique PC needs that are rarely addressed. PC intervention and policy development is vital to ensure they receive necessary care and support. This research aims to guide the development of PC interventions to improve care for older adults in these settings. Importance The importance of this work lies in its recognition of the growing need for palliative care in Assisted Living and Care Homes for older adults, who often face complex healthcare challenges near the end of their lives. By conducting a systematic review and policy analysis, this research provides valuable insights to inform the development of policies and interventions aimed at ensuring that older adults in these facilities receive appropriate and compassionate palliative care, ultimately enhancing their quality of life and end-of-life experiences. Objective(s) The objective of the study is to examine the need for and provision of palliative care (PC) in Assisted Living and Care Homes (AL/CH) from the perspective of residents, family care partners, staff, administration, and outside providers. Scientific Methods Utilized A systematic review of PC qualitative studies published in English between 2013 and 2023. This review aligns with the NPC Consensus Project definition of PC. The study is based on an extensive review of 4,000 articles, with 80 selected for in-depth analysis. The quality of the included studies was assessed using the Critical Appraisal Skills Programme tool. The research includes a synthesis of study elements, NPC domains of care, qualitative themes and policy analysis to discern different levels of PC support in AL/CH facilities based on national PC priorities and funding sources from US, UK, Australia, New Zealand, Canada, and Sweden. Results The study conducted a systematic review of 80 qualitative studies across eight nations, primarily focusing on care staff and facilities in countries with varying levels of government support, and found that more than 80% of the studies were of high quality with implications ranging from local care environments to national and global policy considerations for palliative care in Assisted Living and Care Homes. Perspectives of PC in AL/HC was most frequently obtained through interviews with care staff (59% of studies), family care partners (49%), and residents (43%). The analysis of PC articles revealed varying percentages in different care domains of the NCP consensus statement, with the most prevalent being "Structure and Processes of Care" at 93%, followed by "Care of the Patient Nearing the End of Life" at 74%, while the least prevalent domain was "Cultural Aspects of Care" at 16%. Synthesis of themes were categorized into 4 main groups: 1. Palliative Care Interventions in Residential Care Facilities; 2. Residential PC and Dementia; 3. End-of-Life and Transition Experiences; 4. EOL Care and Communication. Conclusion(s) The findings suggest the presence of PC need for residents in AL/CH. Insights gained from this research will inform the development and implementation of PC interventions in AL/CH facilities. Impact This study reveals a gap in the delivery of PC in AL/CH and is a call to action to develop and implement PC interventions addressing unmet need.