End-of-Life Care in Nursing Homes: The Importance of CNA Staff Communication

Objective

Staff communication has been shown to influence overall nursing home (NH) performance. However, no empirical studies have focused specifically on the impact of CNA communication on end-of-life (EOL) care processes. This study examines the relationship between CNA communication and nursing home performance in EOL care processes.

Design

Secondary data analysis of 2 NH surveys conducted in 2006–2007.

Setting

One hundred seven nursing homes in New York State.

Participants

Participants were 2636 CNAs and 107 directors of nursing (DON).

Measurements

The measures of EOL care processes—EOL assessment and care delivery (5-point Likert scale scores)—were obtained from survey responses provided by 107 DONs. The measure of CNA communication was derived from survey responses obtained from 2636 CNAs. Other independent variables included staff education, hospice use intensity, staffing ratio, staff-resident ethnic overlap index, facility religious affiliation, and ownership.

Methods

The reliability and validity of the measures of EOL care processes and CNA communication were tested in the current study sample. Multivariate linear regression models with probability weights were used. The analysis was conducted at the facility level.

Results

We found better CNA communication to be significantly associated with better EOL assessment (P = .043) and care delivery (P = .098). Two potentially modifiable factors—staff education and hospice use intensity—were associated with NHs' performance in EOL care processes. Facilities with greater ethnic overlap between staff and residents demonstrated better EOL assessment (P = .051) and care delivery scores (P = .029).

Conclusion

Better CNA communication was associated with better performance in EOL care processes. Our findings provide specific insights for NH leaders striving to improve EOL care processes and ultimately the quality of care for dying residents.

Keywords: Staff communication, end-of-life care, quality of care in nursing homes, care process, certified nurse aides