Pain Management for Nursing Home Residents: Results from the 2004 National Nursing Home Survey

Although the percentage of residents with pain is a quality measure for Nursing Home Compare, there is no national information about how pain is managed. The 2004 National Nursing Home Survey, a national probability survey, collected information about pain levels and management strategies in current residents. Data were obtained through interviews with staff, who referred to medical records. Residents are stratified by length of stay (short stay <=100 days and long stay >100 days) and by pain level (moderate and severe/excruciating pain levels in the last 7 days).

Overall, 22.7% of residents had some pain, with more short stay (SS) residents reporting pain than long stay (LS) residents (35% vs. 19.3%). The most common pain management strategy, regardless of stay length, was a PRN pain medication–used for 78.7% of all residents reporting pain. The second most common strategy varied by length of stay. For LS residents, a medication standing order was the second most common method (49.8%) followed by a combination strategy (46.3%). Standing order was more commonly used among residents with severe/excruciating pain than those with moderate pain. Combination strategies were used more than standing orders for SS residents, particularly for those with severe/excruciating pain. Non-pharmacological strategies were used for 29.3% of residents, while special pain management programs were used for only 14.7%. Assessment and management of pain among this population is complex, but considered an important indicator of quality of care as well as quality of life