End-of-life care practices in Korean nursing homes: A national survey

Background: Both globally and nationally, determinants of end-of-life care practices in nursing homes, such as laws and workforce, vary widely, resulting in a huge disparity in the quality of such practices. Despite the rapid growth in the number of nursing homes and increasing social attention being paid to end-of-life care in South Korea, little is known about these practices and how they differ because of nursing home-related regulations and nurse staffing. Objectives: To examine end-of-life care practices in nursing homes and compare them between nursing homes with 30 beds or more and those with fewer than 30 beds (the cut-point where nursing homerelated regulations differ) and between nursing homes with and without registered nurses. Design: A cross-sectional exploratory study using data from a national survey conducted by the National Health Insurance Service. Settings: Nursing homes certified by the national long-term care insurance in South Korea. Participants: Nursing representatives from 836 nursing homes. Methods: Measures of end-of-life care practices included the identification of residents' (or families') preferences for the place of death and a do-not-resuscitate order, the provision of end-of-life care on-site, and the presence of end-of-life care protocols. Descriptive statistics and logistic regression were used to compare end-of-life care practices by bed size and registered-nurse staffing. Results: Of the 836 nursing homes, 85% and 84.1% identified the preference for the place of death and a do-not-resuscitate order mostly from surrogates, respectively. The most preferred places of death were nursing homes (53.3%) and hospitals (46.0%). Approximately, 72% responded that on-site end-of-life care protocols were present, and 50.8% reported providing end-of-life care on-site. Compared to nursing homes with 10-29 beds, those with 30 beds or more were more likely to identify the preference for a do-not-resuscitate order (OR 2.392, 95% CI 1.643-3.482); have in place end-of-life care protocols (OR 1.829, 95% CI 1.341-2.496); and provide end-of-life care on-site (OR 1.556, 95% CI 1.169-2.072). Compared to nursing homes without registered nurses, those with registered nurses were also more likely to identify the preference for a do-not-resuscitate order (OR 1.717, 95% CI 1.142-2.583) and provide end-of-life care on-site (OR 1.663, 95% CI 1.254-2.206). Conclusions: The findings indicate a huge disparity in end-of-life care practices in nursing homes across South Korea by bed size-based nursing-home regulations and registered-nurse staffing. Law/regulationand policy-level changes are needed to promote robust end-of-life care in nursing homes. (C) 2022 Published by Elsevier Ltd.