[Palliative care practices in residential facilities for the elderly requiring full-time care]

The purpose of this study was to assess palliative care practices for residents of Larmont residential facilities for the elderly requiring full-time care (Doubs, France) throughout their stay.

This was a healthcare peer review based on a retrospective clinical audit in compliance with the recommendations of the French Health Authority. The 252-bed Larmont residential care facilities for the elderly is a public institution, attached to the local Hospital. The 72 residents of the Larmont residential care facilities for the elderly who died during 2012 were included in the study.

Death occurred on the premises for 95.8 percent of residents. The proposal to appoint a support person was recorded in 27.6 percent of audited cases. End-of-life instructions were recorded in 23.2 percent of cases. In 31.8 percent of cases, the medical record referred to a multidisciplinary procedure, which complied with regulations in less than one half of cases. The residents’ pain at the end of their life was insufficiently assessed and managed. A discomfort other than pain was identified in 89.2 percent of cases.

This healthcare peer review led to a quality improvement plan focusing on three areas : ensure that medical practices are in line with patients’ rights, anticipate identification of the end of life and improve management of pain and suffering at the end of life.