Making Room for Dying: End of Life Care in Nursing Homes‪.‬

People are dying in nursing homes. This may sound like a clarion call for a new wave of nursing home policing; instead it is a statement of a simple fact that we must embrace. Over 20 percent of older Americans meet their deaths in a nursing home, and 30 percent of all persons dying in hospitals have been transferred there from nursing homes just a few days earlier. Understanding that people die in nursing homes--and should die in nursing homes, just as they should be able to die at home--ought to drive us to improve their care. The literature is already rich with case studies and demonstration projects undertaken by nursing homes to improve care of the dying. Broader change requires a shift in culture and a reframing of the issues. Contemporary standards for nursing home quality and the accepted framework for end of life decision-making have inadvertently placed obstacles in the path of good care for the significant proportion of older people who will spend their final days in a nursing home.