End-of-life orders widely embraced by SNF residents, study finds

Nearly half of all nursing home residents in California completed a form expressing their end-of-life wishes in 2011, showing the state's widespread acceptance of the orders.

That's according to researchers from the University of California-Los Angeles who analyzed data from the Long-Term Care Minimum Data Set to determine how many nursing home residents chose to fill out the voluntary Physician Orders for Life-Sustaining Treatment, or POLST, form.

The POLST form covers residents' end-of-life preferences, including resuscitation orders, aggressiveness of medical treatments and artificial nutrition. The forms must then be signed by the resident, as well as a doctor, nurse practitioner or physician assistant.

So far California is the only state that includes questions on completion of the forms on the MDS.

The first-of-its-kind study included data from 296,276 people residing in one of California's 1,220 nursing homes in 2011. Researchers found completion of the POLST forms grew from 33% at the start of 2011 to 49% by the end of the year.

The forms were more likely to be filled out by long-stay residents and residents without cognitive impairments. The results also showed no differences in form completion among residents based on race or ethnicity.

“POLST is an especially useful tool for nursing home residents because they often experience transitions from the nursing home to the hospital or emergency department and back again,” said lead researcher Lee Jennings, M.D., assistant professor of medicine at UCLA.

The POLST forms can also help reduce unnecessary transfers, and let doctors or other staff know of a patient's' preferences when they change care settings, Jennings said.

There was wide variation in form completion among nursing facilities, with 20% reporting completion of less than 10% of residents, and 40% reporting high completion from more than 80% of residents.

The study's authors contribute the widespread adoption of the POLST forms to state legislation and grassroots efforts to educate providers and consumers about the benefits of the forms. The study's results also show how the MDS can be used to target quality improvement within nursing homes, researchers said.

Results of the study were published online, ahead of print publication in the Journal of General Internal Medicine.