End-of-Life Care Processes in Nursing Homes: The importance of communication and coordination among certified nursing assistants (CNAs)

Staff communication and coordination were shown to influence overall nursing home (NH) performance. However, no empirical studies focused specifically on the impact of CNA communication/coordination on end-of-life (EOL) care processes. This study examines the relationship between CNA communication/coordination and nursing home performance measured by EOL care processes.

Data from two prior (parent) NH studies conducted in 106 NHs in NYS, in 2006-07, are used. Measures of communication/coordination were derived from survey responses obtained from 2,623 CNAs. Measures of EOL care processes were obtained from survey responses provided by 106 directors of nursing (DON). The analysis is based on facility-level data.

The dependent variables are measures of EOL assessment and care delivery (5-point Likert scale scores). The two dependent variables and the communication/coordination measure have been demonstrated to be psychometrically reliable and valid. Other independent variables include hospice use intensity, staff-resident ethnic overlap index, staffing, staff mix, and ownership. Multivariate linear regression models with probability weights are employed.

Consistent with our hypotheses we find better CNA communication/coordination is significantly associated with better EOL assessment (p = 0.003) and care delivery (p= 0.018). Facilities with greater racial/ethnic concordance between staff and residents demonstrate better EOL assessment (p = 0.063) and care delivery scores (P = 0.027). Facilities with greater reliance on hospice are associated with better EOL care delivery (p = 0.012)

CNA communication/coordination impacts EOL care processes. Our findings provide specific insights for nursing home leaders striving to improve EOL care processes and ultimately the quality of care for dying residents.