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Developing an End-of-Life Program for Long Term Care Residents

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Background: An end-of-life program, the Butterflies Are Free Program, was developed at Life Care Center, a long term care facility in Sarasota, Florida, to provide residents with comfort and dignity during the end stage of life.

PI Team: A PI team identified the goal: "Establish an end-of-life program that maintains comfort and dignity for the resident involving the family, residents, and staff in the plan of care at their personal level of comfort. The end-of-life program should put no financial strain on the family." The program entailed involving the resident and family in the end-of-life care plan, which included consideration, for example, of pain medications, spiritual support, and continuing or discontinuing routine medications. The project team began meeting in August 2002, and the program was formally implemented in December 2002.

Results: A preintervention (control group), which covered 11 months, was compared with a 2003 postintervention group, which covered 13 months. Data indicated that the number of residents receiving pain medication during the dying process increased by 27.3%. The facility team members received thank you notes and cards from 41% of the families whose loved one died. The initiative reduced the out-of-pocket expenses to the dying resident and their family by 48%.

Discussion: Review of the 2003 data prompted the development of new goals for 2004 and a refinement of the end-of-life program. This program could be easily duplicated in any long term care facility.

Document Type: Research Article

Publication date: June 1, 2005

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  • Published monthly, The Joint Commission Journal on Quality and Patient Safety is a peer-reviewed publication dedicated to providing health professionals with the information they need to promote the quality and safety of health care. The Joint Commission Journal on Quality and Patient Safety invites original manuscripts on the development, adaptation, and/or implementation of innovative thinking, strategies, and practices in improving quality and safety in health care. Case studies, program or project reports, reports of new methodologies or new applications of methodologies, research studies on the effectiveness of improvement interventions, and commentaries on issues and practices are all considered.

    David W. Baker, MD, MPH, FACP, executive vice president for the Division of Healthcare Quality Evaluation at The Joint Commission, is the inaugural editor-in-chief of The Joint Commission Journal on Quality and Patient Safety.

    Also known as Joint Commission Journal on Quality Improvement and Joint Commission Journal on Quality and Safety
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