4 Pillars of change for a palliative ready nursing home

As Singapore's population ages, nursing homes (NHs) are becoming the final home for many elderly individuals. This shift highlights the urgent need for NHs to go beyond basic care and provide meaningful palliative support to meet the complex needs of residents in their final stages of life. However, implementing palliative care in NHs isn't without its challenges—from limited training to resource constraints and cultural barriers within these institutions.

For years, palliative care has primarily been the focus of inpatient hospices, leaving NHs to concentrate on custodial care. This division has created a significant gap, with NH residents often missing out on the quality end-of-life care they need. Research by Hockley et al. (2013) reveals that many NH staff feel underprepared to provide this level of care, which can lead to unnecessary hospitalizations and poorly managed symptoms. Addressing this gap requires a multi-faceted approach involving cultural changes, better policies, training, and collaboration with specialists. Let’s explore how NHs can make this transformation.

1. Shifting Mindsets

The first step is a mindset shift. Palliative care must be seen as an integral part of NHs, with all staff—from doctors and nurses to volunteers—embracing their role in providing holistic care. Meeting the physical, emotional, and spiritual needs of residents should be a shared goal. As the Singapore Hospice Council (2015) emphasizes, palliative principles must be embedded across all healthcare settings to ensure patient-centered care.

2. Policies That Empower

Policies play a critical role in making palliative care possible. For example, flexible visitation policies can allow families to support their loved ones in meaningful ways during their final days. However, balancing these compassionate policies with practical concerns like infection control is key. The Ministry of Health's National Strategy for Palliative Care (2023) provides a framework for ensuring timely and accessible palliative care for all.

3. Training Staff for Holistic Care

Palliative care requires specialized skills. Staff must be trained to manage symptoms, offer emotional and spiritual support, help families cope, and practice self-care to prevent burnout. Programs like Singapore’s GeriCare have been instrumental in equipping NH staff with these skills, leading to tangible improvements, such as fewer emergency hospitalizations (Ho et al., 2022). In Europe, initiatives like the PACE Steps to Success provide a model for staff education and organizational change to enhance end-of-life care (Van den Block et al., 2016).

4. Building Collaborative Partnerships

NHs don’t have to do it alone. Partnering with specialist palliative care teams can provide much-needed expertise, help develop policies, and offer training. Globally, initiatives like the UK’s Gold Standards Framework and Canada’s shared-care models demonstrate how collaborative approaches can elevate palliative care standards. These models emphasize education, teamwork, and systematic planning to address residents' needs effectively.

Conclusion

Transforming NHs into spaces where residents can live their final days with dignity and comfort is both a challenge and a necessity. With the right strategies—shifting mindsets, creating supportive policies, training staff, and fostering collaboration—NHs can rise to the occasion. Let’s ensure that palliative care becomes the norm, not the exception, for those who need it most.

References

Ersek, M., Unroe, K. T., Carpenter, J. G., & Cagle, J. G. (2022). High-quality nursing home and palliative care—One and the same. Journal of the American Medical Directors Association. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8821139/

Hermans, S., Sevenants, A., & Declercq, A. (2019). Integrated palliative care for nursing home residents: Exploring the challenges in the collaboration between nursing homes, home care, and hospitals. International Journal of Integrated Care. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6450250/

Hewison, A., Shaw, K. L., Badger, F., & Plumridge, G. (2012). An evaluation of the impact of the Gold Standards Framework on collaboration in end-of-life care in nursing homes. International Journal of Nursing Studies. Retrieved from https://www.sciencedirect.com/science/article/pii/S0020748911004184

GeriCare. (n.d.). Training Hub. Retrieved from https://www.gericarenorth.com/training-hub

Ho, P., Lim, Y., Tan, L. L., Wang, X., Magpantay, G., Chia, J. W., Loke, J. Y., Sim, L. K., & Low, J. A. (2022). Does an integrated palliative care program reduce emergency department transfers for nursing home palliative residents? Journal of Palliative Medicine, 25(3), 361–367. https://doi.org/10.1089/jpm.2021.0436

Hockley, J., Watson, J., Oxenham, D., & Murray, S. A. (2010). The integrated implementation of two end-of-life care tools in nursing care homes in the UK: An in-depth evaluation. Palliative Medicine, 24(9), 828–838. https://doi.org/10.1177/0269216310373162

Ministry of Health. (2023). Launch of the 2023 National Strategy for Palliative Care. Retrieved from https://www.moh.gov.sg/newsroom/launch-of-the-2023-national-strategy-for-palliative-care

Singapore Hospice Council. (2015). National Guidelines for Palliative Care. Retrieved from https://www.singaporehospice.org.sg/wp-content/uploads/National-Guidelines-for-Palliative-Care-Revised-Ed.-Jan-2015.pdf

Singapore Hospice Council. (n.d.). Palliative Care Education. Retrieved from https://www.singaporehospice.org.sg/palliative-care-education/

Van den Block, L., Onwuteaka-Philipsen, B., Meeussen, K., & et al. (2016). Comparing Palliative Care in Care Homes Across Europe (PACE): Protocol of a Cross-Sectional Study of Deceased Residents in 6 EU Countries. Retrieved from https://www.jamda.com/article/S1525-8610(16)30047-0/fulltext