End-of-life care at long-term care facilities for elders in Incheon

초록

This study is aimed at understanding end-of-life care provided at long-term care facilities in Incheon. Interview survey was conducted at 97 facilities using questionnaires with a staff in charge of end-of-life. Questionnaire was reviewed by 3 experts and pretested at 5 facilities. Of the physical care, more than 90% of the facilities provided vital sign check, position change for relieving dyspnea, change food type, skin hygiene, and position change for preventing pressure ulcer. Psychosocial care provided in more than 90% of the facilities included providing services with talking although unconscious or non-responding state, helping the elder express his/her needs, and helping good-bye by making family visit. Spiritual care provided at more than 80% of the facilities was to respect faith or spiritual belief of the elder, to listen to the elder, to pray together or read religious scriptures, and to be with the elder when desired. Mortuary care was conducted at 76% of the facilities; cleaning the body was provided at 78.3% only. Employment of a registered nurse showed a significant difference in providing nasogastric nutrition (p=.035), administration of analgesic (p=.022), informing end-of-life state to the elder (p=.020), helping good-bye by making friends and acquaintances visit (p=.023), and helping express feelings related to death (p=.002), identifying tube or equipment to remove after death (p=.045). Of the respondents, 76.4% were satisfied with the services provided in the facilities. As for the problems related to end-of-life care provided in the facilities, respondents indicated indifference of family members, difficulty in obtaining medical prescription, difficulty in predicting death, lack of staff education, and having no room for death. Specific guideline should be developed to enhance end-of-life experiences and caring services in facilities. Staff members need a particular support with adequate educational experiences.