Abstract
The majority of nursing home residents have some level of dementia and, therefore, recommendations to improve the quality and accessibility of palliative care in this setting need to reflect the unique needs of this population. Current literature and relevant research studies were reviewed focusing on the utilization of hospice, end-of-life care, and pain and symptom management in the nursing home. It is important to understand the environment in which nursing homes must operate, including regulatory requirements and biases, access to hospice benefits, and staffing patterns and clinical skills. Furthermore, the needs of the cognitively impaired relating to competency, advanced directives and pain assessment also must be incorporated into quality end-of-life and palliative care. This article reviews the issues and challenges involved in offering palliative care in the nursing home and emphasizes the benefit of a dementia-based initiative.