Care for Dying Patients in a Skilled Nursing Facility: A Train-the-Trainer Program

A growing number of patients are dying in skilled nursing (SN) facilities. It is estimated that by the year 2020 up to 40% of United States’ deaths will occur in nursing homes. Many of the facilities are under prepared to care for patients at the end of life. In order to meet the needs of these patients, CHI Franciscan Hospice developed a train-the-trainer program in partnership with representatives from the SN facilities. Seed grant money for this project was provided by the Robert Wood Johnson Executive Nurse Alumni Association. This presentation will discuss both collaborative development of the curriculum and the results of the five session training program.

The curriculum was divided into five sessions occurring one month apart. After each session, SN staff were asked to go back to their facility and do a training session based on the information and tools from that session. One of the unique aspects of this project was the opportunity to debrief at the beginning of each session.

Session content included:

• An overview of hospice services in skilled nursing facilities including discussion of “what is a good death,” how to collaborate with hospice to provide care and what is the regulatory environment.
• Communication and relationships including discussion of advance directives, how to have difficult conversations about dying with patients and families and how to collaborate with hospice on developing a plan of care.
• Pain and symptom management.
• Regulatory and Compliance including discussion about what the regulatory environment is for both hospice and for skilled nursing facilities.
• Bereavement. Discussion of bereavement for families and for staff who have long-term relationships with patients.

The ELNEC Geriatric Curriculum provided the evidence based framework for the sessions.