Quality end-of-life care is essential for the over 1.4 million Americans who reside in nursing homes and assisted living facilities (Fact 1). For many individuals, these long-term care settings will be where they take their last breaths. However, research shows that nursing homes often fall short in providing comprehensive, compassionate end-of-life care. Studies reveal that nursing home residents frequently experience uncontrolled pain, inadequate symptom management, and poor communication in their final days (Fact 2).

Several factors contribute to the challenges in delivering optimal end-of-life care in nursing homes. A high proportion of residents have dementia or other cognitive disabilities that complicate care planning and pain management (Fact 3). Few residents have documented their treatment wishes, leaving staff unsure how to proceed (Fact 4). Heavy staff workloads and lack of end-of-life care training also impede quality care. Communication breakdowns between staff and family members are common, leading to conflict and dissatisfaction with care (Fact 5).

It is imperative that nursing homes address these barriers and improve end-of-life care. This requires making it a priority through training, resources, and new models of care. With compassionate, resident-centered care, nursing homes can greatly enhance quality of life at the end of life for residents and their families. This article will explore evidence-based strategies and best practices to improve end-of-life care in nursing home settings.

Staff Training and Education

High quality end-of-life care requires that nursing home staff have adequate training in key areas impacting care for dying residents. Studies clearly demonstrate that staff education and training on end-of-life care leads to improved resident outcomes and enhanced family satisfaction (Fact 16). This includes training and renewal of certification in skills like Basic Life Support (BLS), Advanced Cardiac Life Support (ACLS), communication strategies, dementia care, pain assessment, and more.

Despite the benefits, research reveals that nursing home staff often lack preparation to provide quality end-of-life care. In surveys, nurses report feeling unsure of how to manage symptoms, make residents comfortable, and have meaningful conversations about death and dying (Fact 7). With inadequate training, staff are ill-equipped to meet the complex physical, psychosocial and spiritual needs of residents at the end of life. Outdated attitudes and knowledge gaps regarding pain management are common. This contributes to the high rates of untreated pain observed in nursing home residents near death (Facts 2, 13).

Targeted education and training interventions can begin to address these deficiencies. Programs like the Gold Standards Framework in care homes provide nursing home staff with practical guidance on delivering excellent end-of-life care (Fact 20). Other curriculum like the Route to Success program empower staff with the skills needed for resident-centered care. Ongoing competency-based training is key to ensuring excellence.

Strategies for Improving End-of-Life Care

Beyond investing in staff education, nursing homes need to implement comprehensive strategies to transform end-of-life care. A multifaceted approach should focus on enhancing communication, expanding access to hospice and palliative care, improving symptom management, and increasing collaboration.

Effective communication is essential but often lacking in nursing homes at the end of life. Facilities need structured processes to facilitate information sharing between staff members across shifts and departments (Fact 5). This ensures consistent, coordinated care. Ongoing communication with families through meetings and bedside conversations is also key. Discussing goals of care early and often alleviates confusion when residents decline.

Increasing utilization of hospice and palliative care services can provide enormous benefit. 

Patients enrolled in hospice have improved pain control, fewer hospitalizations, and better quality of life (Facts 6, 18). Yet referral to hospice by nursing homes is often late, missing opportunities for comprehensive care (Fact 9). Earlier discussions about palliative care and hospice enrollment are vital.

For residents not enrolled in hospice, nursing homes struggle with providing adequate symptom management, especially pain control. Expanding staff competencies in assessing and managing pain is essential (Fact 11). Taking a comprehensive approach that addresses common end-of-life symptoms will improve quality of living and dying for residents.


The growing number of older Americans underscores the vital role nursing homes play in providing compassionate, dignified end-of-life care. Yet many facilities struggle to meet the complex needs of their dying residents. Challenges like inadequate staff training, poor communication, lack of palliative care integration, and ingrained cultural attitudes impede the provision of optimal care.

Targeted interventions and new models of care are demonstrating that excellence in end-of-life care is an achievable goal. When nursing homes invest in comprehensive staff education on palliative care, adopt formal strategies to enhance communications, expand access to hospice services, and focus on pain and symptom management, they can greatly improve the dying experience. This requires strong leadership and an organizational commitment to making end-of-life care a priority, not an afterthought.

The stories of nursing home residents facing death with untreated pain, fear, and lack of comfort are heartbreaking. But with dedication to implementing evidence-based best practices, these stories can be ones of peaceful acceptance, meaningful connection, and profound personal growth in the final chapter of life. The rewards for residents, families, staff, and communities make the effort worthwhile. The time has come for all nursing homes to step up and fulfil their duty to provide exemplary end-of-life care.

By Punit