Implementing an Integrated Palliative Care Pathway in Long-term Care Facilities

Long-term care facilities (LTCFs) care for residents with frailty, dementia, and progressive illness, yet palliative care needs are often recognized late. The Modena Local Health Authority developed a pathway to improve identification and integration with the Local Palliative Care Network.

Baseline measures from seven LTCFs and a province-wide survey of 53 LTCFs included SPICT-estimated palliative care needs, individualized palliative care plans, place of death, and data completeness. After implementation, measures included resident characteristics, diagnoses, vital status, place of death, and hospitalizations before and after referral.

Procedure DS.DO.171 used the surprise question, SPICT, Palliative Prognostic Index, multidisciplinary review, goals-of-care discussions, referral to the Home Palliative Care Unit, and definition of care complexity. Second-level support was provided by a general practitioner with special interest in palliative care, working with a palliative care nurse and network professionals.

From April to December 2024, 405 residents were enrolled; mean age was 87.1 ± 8.5 years and 70.9% were female. Dementia, neurological disease, and cancer were most frequent. Among 250 deaths, 245 (98.0%) occurred in LTCFs. Mean hospitalizations decreased from 0.96 to 0.04 after referral.

An organization-wide palliative care pathway in LTCFs appears feasible and may support end-of-life care in facilities, although findings require cautious interpretation.