Living, and dying, in a nursing home

8th in a 12-part series

We have a picture in our minds of what nursing homes are like: places that are at once too sterile and yet too ripe with the smells of aging; wheelchairs lined up in corridors, their occupants waiting, some more vacantly than others, for something to happen.

No surprise, then, that nursing homes are not the first place people choose for their last days. And a report in November from Last Acts, a national end-of-life coalition, didn't help, giving Utah nursing homes a D average grade for their ability to control pain in terminally ill patients.

But like other parts of the health care system, nursing homes have begun to re-think how people live and die in their facilities.

The good nursing homes, say the people who study them, provide the essentials of end-of-life care: attention from people who have grown to love you, who care that you are comfortable, who work to help you keep your dignity and self-worth until the end. When a cure is not possible, they move beyond that to palliative care, controlling pain and symptoms while providing emotional and spiritual support.

"When it's done well, it's a similar experience to being surrounded by a loving family in your own home," says Dr. Steve Fehlauer, who provides physician care to several Salt Lake Valley nursing homes.

Nursing homes are about life in slower motion. There's less of the bustle and drama of hospitals and more consistent care from the same aides, providing a gentle continuity, all of which makes nursing homes often more conducive to end-of-life care.

Dr. Patricia Berry, assistant professor at the University of Utah College of Nursing, has studied nursing homes in Wisconsin and Utah. When things go well in nursing homes, she says, they go really well. "I'm heartened by stories of nursing assistants. . . . They connect with residents and their families in a way we don't see in other settings."

Or, as Dr. Mary Jane Norman, medical director of Christus St. Joseph's Villa in Salt Lake City, says, "We try to make sure the care is being delivered by the same person, so it's not some stranger pulling your pants up or feeding you."

The flip side of all that personal care is that it's delivered by smaller numbers of health-care workers — generally about one-third — than in hospitals, says Fehlauer.