Understanding End of Life Care Nursing

The services nurses provide are crucial in ensuring proper and effective patient care. This is especially true in skilled nursing facilities (SNFs), long-term care facilities, and nursing homes, where residents require medical aid in a number of aspects of their daily life. In these types of facilities, end of life care is unfortunately one of the skills nurses provide.

End of life care can be an important tool for patients and their families. In one of the most difficult times in their lives, this can help make residents and families more comfortable, from physical discomfort to mental and spiritual preparations.

This post will explore how end of life care nursing works in SNFs and other care facilities, and what these facilities need to know about these treatments.

What Is End of Life Nursing Care?

End of life nursing care consists of health care provided by nurses and nursing facilities as a resident approaches death. This can include anything from caring for their physical well-being, whether pain management or addressing other symptoms, ensuring emotional, mental, and spiritual or religious needs are met, and helping with daily tasks that may no longer be possible or attainable for the resident.

Often, this includes palliative care, which is concerned with handling pain and other symptoms of chronic or terminal illness. This does not necessarily have to be end of life care, but could be applicable for those undergoing cancer treatment or care for another chronic pain condition. And conversely, palliative care might not be required for end of life care.

End of life nursing doesn’t have to be administered in a very short timeframe, either. It does refer to care provided surrounding death, but it’s not limited to the minutes or hours immediately before. It can cover weeks or months of treatment beforehand, which can be used to make the patient or resident more comfortable.

Every person is different, meaning care at the end of life can cover many different forms and periods of time, and is tailored to the specific needs of each individual. There are some treatments that are more common than others when it comes to end of life care.

Pain Management

Pain management is one of the most common types of care that will be provided at the end of life. This can coincide with treatments for other conditions, but generally aims to reduce discomfort and provide the least disruptive experience possible for the resident.

In end of life care specifically, current best practices recommend taking all possible measures to manage pain, without concern for the potential long-term negatives, like addiction and increasing tolerance. The goal is to provide the most comfortable experience possible for the resident.

Difficulty Breathing

Having trouble breathing is uncomfortable for the healthiest of people, so for someone undergoing care at the end of their life, it’s a massive disruption to their daily life. Depending on the severity of the shortness of breath, SNF staff may administer medication like morphine to ease the symptoms. Less severe symptoms could be aided by opening windows, adding a humidifier, raising the resident’s head or torso, turning on a fan, using topical treatments, and more.

Bronchodilators can also be used to alleviate problems with breathing and may be prescribed by a doctor as part of the patient’s treatment. Other advanced care might include oxygen therapy through a tube or mask, and may be mobile or administered at the resident’s bedside.

Temperature Management

Managing temperature is one of the most important controls for maintaining comfort. Being too hot or too cold can make it difficult for the body to regulate certain processes, making it difficult for patients to live day-to-day life without discomfort.

In addition, aging often reduces the quality of circulation, leaving older people more prone to cold. Discomfort in the extremities is common, and poor circulation in the hands and feet can cause reddening in the skin or even a blueish cast. Ensuring that the temperature in a resident’s room is sufficient to keep them comfortable and avoid any of the discomfort from extreme temperature can go a long way in effective end of life care.

Pressure Injuries and Skin Conditions

For many nearing end of life, much of their time will be spent in bed or in a chair, increasing the risk of pressure injuries like bed sores. Bed sores can be very uncomfortable to the patient, and in extreme cases, can be deadly. Proper end of life care ensures that the resident is moved frequently to avoid keeping pressure on any one spot for too long.

In the event that a pressure injury does develop, caring for the resulting wound is a key part of end of life nursing. This may coincide with pain management, as bed sores can be quite uncomfortable and painful for the patient.

Caring for Chronic Conditions

Many who are approaching end of life may be suffering from chronic or terminal conditions. Caring for these conditions is key in providing quality end of life care. Chronic and terminal conditions come with many symptoms of a wide variety, and may overlap with other forms of care provided. Pain management if likely needed with many chronic conditions, and difficulty breathing is relatively common.

Understanding what treatments are needed for the resident’s condition is the first step. Then consider along with the resident’s medical team, how they may be adapted for end of life care, as is the case with pain management. Always remember the guiding principle for end of life care: comfort is the goal.

How Is This Different from Other Types of Nursing?

There are many nursing specialties. End of life nursing isn’t a specific specialty, and refers more to the type of care provided than the type of practitioners performing it. However, there are several similar specialties of nursing that may be involved in providing or supporting a resident’s care at the end of life.

• Burn care nurse: These nurses provide treatment for individuals who have sustained minor or significant burns. As such, they may encounter patients who need end of life nursing care. However, this specialty is unlikely to practice in SNFs or nursing homes.
• Critical care nurse: Critical care nurses work in intensive care units (ICUs) with patients who are in critical condition or recovering from a severe injury. Some of these patients will require end of life care, but as with burn care nurses, these nurses practice in hospitals rather than long-term care facilities.
• Geriatric nurse: These nurses look after patients who are elderly and at a higher risk of infection and disease. With advanced age, along with the increased risk of illness, comes the increased risk of death. Geriatric nurses often work with patients who are nearing the end of life, and are frequently employed at SNFs, nursing homes, and even in home-based care for the elderly.
• Oncology nurse: Oncology nurses work with cancer patients. As a result, they frequently help patients who may be terminal and offer palliative care. Much like critical and burn care nurses, this specialty is often found in hospitals, but can also provide care in home-health settings and private practice.

Several nursing specialties may encounter patients at the end of life, but the most commonly found in SNFs, long-term care facilities, and nursing homes are geriatric nurses.

How Do You Code for End of Life Care?

There are some regulations and codes that impact how facilities can administer and document end of life treatment. Many regulatory bodies, like the Centers for Medicare Services (CMS) and the National Institute of Health (NIH), have slightly differing definitions on “end of life care”, “hospice care”, “palliative care”, and “comfort care”, though they’re all quite similar.

When it comes to International Classification of Diseases (ICD-10) coding, “end of life”, “comfort”, and “hospice” care aren’t specified as their own codes. “Palliative care,” on the other hand, is. Generally, this is because “end of life,” and most of its synonyms, are not a diagnosis of their own. The cause of the need for comfort care would be specified by a different ICD-10 code and assessed prior to the onset of end of life care. ICD-10 code Z51.5 describes an encounter for palliative care and is the only ICD-10 code that can be applied for end of life, palliative, or comfort care.

However, Current Procedural Terminology (CPT) codes should be applied based on the care provided to the patient, for pain management, cancer treatment, wound care, or any treatment to care for chronic illnesses.

Tools for End of Life Nursing Care

Like other kinds of care, end of life care is made much easier for provider and patient with tools to aid in compliance, documentation, and analytics. For SNFs, not only can tools help with administering care to residents, but they can also help with administration of the facility itself.

Electronic health records (EHRs) are a key tool for SNFs to manage end of life care for residents. Understanding the scope of a resident’s treatment and care is critical to offering safe and accurate end of life care. As of the end of 2018, 84% of nursing facilities in the US used an EHR. At that point, the lack of interoperability—or the sharing of information between different EHRs—was a major barrier to sharing clinical information among nursing facilities. Now, interoperability is a major focus of EHRs.

Choosing the right EHR depends on the specific needs of a facility. It’s likely that interoperability will be a big concern, considering the varied and extensive care that is typically required for end of life patient care.

Compliance is also a big concern for SNFs and long-term care facilities. Accurate and timely reimbursement depends on compliance with Medicare and Medicaid guidelines. The right tools will help ensure data is complete and consistent, reducing inconsistencies in coding and preventing any issues with incomplete reimbursement.

End of life care is unique in another way for long-term care facilities—there’s less of a need to focus on reducing readmissions. In general, these residents are in SNFs to manage chronic conditions and pain and are less likely to be discharged and then readmitted later. However, for SNFs that provide care for a range of residents with a host of concerns, analytics can provide insight to help reduce readmission rates.

Analytics are an important tool for SNFs regardless of whether end of life is the only form of care provided. Some tools can assess a facility’s data to understand strengths and weaknesses, prevent adverse situations, identifying risk factors for residents, and improving facility performance. In turn, this can increase an SNF’s Five-Star rating. For patients and families looking for a nursing home or SNF for end of life care, this rating can be an encouraging indicator that a facility takes this seriously and will be a comfortable and capable environment.

Comfort Is Key for Successful End of Life Nursing Care

End of life care is driven by the guiding principle that comfort is king. The care provided should all be geared towards ensuring that the resident’s day-to-day is as comfortable as possible. This may mean that medications like pain relievers are administered differently than in other nursing specialties, which may be more concerned with the long-term effects of these medications.

Many nursing specialties may provide end of life care, especially those working in SNFs, nursing homes, and long-term care facilities. And for these facilities, quality EHRs and analytics tools can make a huge difference in these facilities’ ability to provide quality end of life care for residents.

SNFs and long-term care facilities provide immensely helpful end of life nursing care for the residents that need it. These facilities focus on the needs of the patient in order to offer this high quality care.