Palliative Care Consultations for Persons with Alzheimer's Disease and related Dementia in the Medicare Skilled Nursing Facility (SNF) Setting
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Abstract of the Proposed Research Alzheimer’s disease and related dementias (ADRD) are serious, life limiting illnesses with no known cure. The majority of persons with advanced dementia die in nursing homes (NHs) and 40% receive post-acute skilled nursing facility (SNF) care in NHs in the last 3 months of life. SNF care is a Medicare post-acute rehabilitation service delivered in NHs focused on intense rehabilitation and/or aggressive, disease-modifying therapies. Regardless of life expectancy, use of SNF care typically precludes access to Hospice services. This has profound implications for the quality of life and end-of-life experience for persons with ADRD. However, there is no regulatory barrier to the receipt of palliative care (PC) services delivered by healthcare providers concurrent with SNF care. PC is patient- and family-centered care that incorporates symptom assessment and management and open communication and documentation of patients/families’ goals of care and & preferences for treatments. However, there is little scientific evidence about the processes and outcomes of SNF PC for individuals with ADRD in NHs. The proposed supplemental study is uniquely positioned to address such gaps in science by leveraging existing study protocols, procedures, and infrastructure of a currently funded study (1K23NR017663-01A1) to expand its focus on ADRD. Specifically, we will conduct a two-arm non-randomized controlled pilot clinical trial, enrolling 50 persons diagnosed with ADRD who are in SNF care to establish the feasibility of the SNF-PC intervention, estimate the effect size of the SNF-PC intervention on patient/family caregiver reported quality of life, symptom management, and satisfaction with care, and compare the demographics, clinical characteristics, and palliative care needs of people with ADRD versus non ADRD serious illnesses during post-acute SNF care in NHs. Currently, there is no existing empirically derived model for PC for people with ADRD in NHs receiving SNF care; the proposed supplement is highly likely to stimulate novel and impactful advances in clinical practice and scientific inquiry. It also seeks to shift the current models of dementia care in SNFs to a person-centered model with an evidence- based practice that can enhance the quality of life for people with ADRD and promote goal-directed care.
