Original Study| Volume 11, ISSUE 7, P494-499, September 2010

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

  • Nan Tracy Zheng
    Address correspondence to Nan Tracy Zheng, Department of Community and Preventive Medicine, University of Rochester School of Medicine and Dentistry, 601 Elmwood Avenue, Box 644, Rochester, NY 14642.
    Department of Community and Preventive Medicine, University of Rochester School of Medicine and Dentistry, Rochester, NY
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  • Helena Temkin-Greener
    Department of Community and Preventive Medicine and Center for Ethics, Humanities, and Palliative Care, University of Rochester School of Medicine and Dentistry, Rochester, NY
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Published:August 02, 2010DOI:


      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.


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


      One hundred seven nursing homes in New York State.


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


      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.


      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.


      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).


      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.


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