Palliative care practices in residential facilities for the elderly requiring full-time care

Aims: The purpose of this study was to assess palliative care practices for residents of Larmont residential facilities for the elderly requiring full-time care (Doubs, France) throughout their stay. Methods: This was a healthcare peer review based on a retrospective clinical audit in compliance with the recommendations of the French Health Authority. The 252-bed Larmont residential care facilities for the elderly is a public institution, attached to the local Hospital. The 72 residents of the Larmont residential care facilities for the elderly who died during 2012 were included in the study. Results: Death occurred on the premises for 95.8 percent of residents. The proposal to appoint a support person was recorded in 27.6 percent of audited cases. End-of-life instructions were recorded in 23.2 percent of cases. In 31.8 percent of cases, the medical record referred to a multidisciplinary procedure, which complied with regulations in less than one half of cases. The residents' pain at the end of their life was insufficiently assessed and managed. A discomfort other than pain was identified in 89.2 percent of cases. Conclusions: This healthcare peer review led to a quality improvement plan focusing on three areas: ensure that medical practices are in line with patients' rights, anticipate identification of the end of life and improve management of pain and suffering at the end of life.