Opportunities for Improving End-of-Life Care for Veterans Receiving Hospice in Community Nursing Homes

The Department of Veterans Affairs (VA) has demonstrated a longstanding commitment to ensuring that veterans receive high-quality end-of-life care, including hospice services. Despite its growing use, evidence suggests that the quality of end-of-life care is lower among veterans receiving hospice in VA-contracted community nursing homes (CNHs) compared with VA inpatient settings. The objective of this analysis was to explore the perspectives of bereaved family members of veterans who received CNH-based hospice care to identify opportunities for improvement.

Qualitative analysis of open-ended survey responses.

Next of kin of a national cohort of 450 veterans who died between October 2022 and September 2023 while receiving VA-contracted hospice care in CNHs who responded to at least one of the open-ended items on VA's Bereaved Family Survey.

Using conventional content analysis of Bereaved Family Survey responses, themes were collaboratively identified within inductively identified, overarching domains. Direct recommendations from respondents were also identified.

We identified 6 overarching domains: (1) CNH staff interactions reflected comments related to staff demeanor, communication, and attentiveness; (2) VA's role in CNH-based hospice care encompassed themes related to available options for hospice care, CNH screening and oversight, VA involvement, and benefits; (3) hospice care delivery and coordination included comments related to hospice team communication and care delivery, as well as coordination of care with the CNH; (4) CNH resources focused on CNH staffing levels, environmental conditions, and available services; (5) attention to personal care needs by CNH staff included themes related to food and hydration, skin care, and toileting; and (6) symptom management focused on how pain and other symptoms were managed by staff.

Efforts are needed to improve care coordination, role clarity, and VA oversight to optimize the quality of the end-of-life care experience for veterans who receive CNH-based hospice care.