What do you think?
- Looking at these results over time, are there differences between zones? Between designated supportive living and long term care? What factors could account for these differences?
Whether you’re a patient, provider, or health system administrator, thinking about why these differences might exist can start conversations and lead to solutions for improved quality of healthcare.
Data courtesy of Alberta Health Services and Alberta Health
Understanding “location of death”
This measure reports the location of designated supportive living or long term care residents who died, whether at home at their continuing care site or in acute care (hospital).
People who live in continuing care are at a sensitive point in their care journey. They have specific health needs, medical complexities, and functional dependencies that require a level of care and support that can typically be effectively provided in these settings. All of these factors, and sometimes due to frailty, mean that designated supportive living and long term care residents tend to be at a higher risk of serious decline in health status and death.
Death for continuing care residents can occur at their continuing care site or in acute care.
If a resident is approaching their end of life time, sites work hard to meet residents’ physical (e.g., pain), emotional, and spiritual needs at this time in their care journey. Sites aim to honour the person’s (and loved one’s) choices with respect to end-of-life care, which can include the person’s preferred choice for location of death.
For instance, a resident may prefer to die around familiar caregivers and in a familiar room, away from the less familiar and high tech environment of a hospital. In such cases, the care and support that a resident needs may be consistent with the skills and resources available at a site.
However, variation can exist with respect to individual preferences and the specifics of a resident’s medical condition, which sometimes results in admission to the hospital, especially in the event of an unexpected health crisis. For instance, a resident (or loved ones) may prefer a type of treatment that is not available at their site, or a resident may experience a symptom (e.g., pain) that cannot be diagnosed or managed readily at their site. The condition which led to their transfer to acute care sometimes results in their death in acute care.
This measure only reports on the location of death for continuing care residents. It does not provide insights into the resident or loved ones’ experience with their end-of-life care.
Considerations when viewing the results:
When thinking about residents who die at their continuing care site or in acute care, providers and leaders can consider a number of things to better understand and improve these results. Some questions they could ask before taking action include:
- What supports are available to sites and in acute care to help residents and their loved ones through death and dying? How are residents and their loved ones made aware of these supports? What are the gaps in support? How could these gaps be addressed?
- How is advance care planning and a Goals of Care Designation considered when making a decision about a transfer to acute care?
- How might a loved one’s involvement impact these results?
- How can designated supportive living and long term care sites be better equipped and prepared to provide palliative and end of life care to prevent unnecessary or unwanted (resident preference) transitions to acute care?
The Health Quality Council of Alberta uses the Alberta Quality Matrix for Health as a way of organizing information and thinking around the complexity of the healthcare system. This measure can be used as input to assess long term care’s performance in these dimensions of quality:
Dimensions of Quality