may be a source of comfort to the dying and is certainly a comfort to the bereaved. The promise that their body will be treated with respect, their family and loved ones promptly notified, etc. While considerable appropriate attention has been given to issues such as advanced directives, pain management and palliative care, feeding and hydration at the end of life, and hospice-nursing home partnerships, little attention has been paid to the appropriate management of the death itself. Certainly, death is no stranger in the long-term care setting. Current estimates are that one quarter of all deaths in the United States occur in nursing homes.
Changes in demographics, in hospital reimbursement methodologies, and in patient preferences, have shifted the location of death away from acute care hospitals toward nursing homes, hospices or hospice home care, continuing care retirement communities, or assisted living facilities. Whether the resident is a chronically ill child, a patient with advanced AIDS, or a frail elder, the populations we care for are seriously, and often terminally, ill. The American Medical Directors Association has demonstrated a longstanding concern to improve the quality of End of Life care in our nation's skilled nursing facilities and throughout long-term care.
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