A model for successful nursing home-hospice partnerships

While benefits of hospice care in nursing homes have been documented, interorganizational challenges such as staff conflicts regarding planned care or their respective roles have also been documented. Through case studies, this research aimed to characterize the partnerships of successful nursing home-hospice collaborators.

Six nursing homes and hospices with self-identified successful collaborations were studied. Interviews of care providers and chief executive and financial officers collected information on practices relating to seven domains identified as critical to the collaboration. The organizational factors and activities relating to infrastructure development and care collaboration and provision most common across sites were identified.

Nursing home-hospice collaborators were philosophically and otherwise aligned; they had similar missions, understood their differing approaches to care, and administrators demonstrated an openness and support for the collaboration. Hospices developed infrastructures to correspond to the uniqueness and complexity of the nursing home environment. For example, they hired nurses with nursing home backgrounds, created teams dedicated to nursing home care, and trained hospice staff in problem solving and conflict resolution. Care collaboration processes focused on the importance of two-way communication by actively soliciting and sharing information with nursing home staff and responding to nursing home staff and administrators' concerns.

While successful collaborators were organizational aligned, hospice leaders' acknowledgement that palliative care provision in nursing homes is complex and unique was important to success. Accordingly, the prevalent partnership model was a product of strategic efforts by leaders aimed at matching their staffing to the nursing home environment and promoting good communication and skills needed for problem solving.