Nursing Home Education

The Coalition for Compassionate Care of California promotes quality, compasionate end-of-life care for California’s nursing home residents. CCCC assists facilities in creating and implementing end-of-life practices that benefit residents and their loved ones.

Nursing Home Projects:

CARE Project
PREPARED Project
ECHO Recommendations
Promising Practices

CARE Project

Compassion and Respect at the End-of-Life

The Coalition for Compassionate Care of California is collaborating with the California Culture Change Coalition to improve end-of-life care in nursing homes by piloting and promoting a clear set of end-of-life practices. The CARE Project revises the ECHO Guidelines, originally released in 2000, and updates the practices that assist nursing homes in honoring resident wishes and providing comfort care at the end-of-life.

The components of the CARE Project include:

Creating broad statewide consensus on end-of-life care practices,
Engaging state regulatory agencies to stimulate improved end-of-life care,
Convening stakeholders to promote practice changes in end-of-life care,
Pilot-testing the new end-of-life practices, and
Capturing the project results in an issue brief.

The project targets nursing home staff, trade association leadership and residents of nursing homes and their families. The project was funded by the California HealthCare Foundation.

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PREPARED Project

Preparing Residents for End-of-life Plans and Respecting End-of-life Decisions

In 2003, Sutter Roseville Medical Center (SRMC) piloted a successful intervention to reduce hospital transfers of nursing home residents. A SMRC nurse worked with a local nursing home to establish advance directives and to improve palliative care skills of the staff. Within six months, transfers from the nursing home to the hospital decreased by 56%. The program was expanded to a second skilled nursing facility where avoidable hospitalizations fell by 50%.

The PREPARED Project expanded this successful pilot to include four hospitals and health systems (Sutter, Kaiser, Catholic HealthCare West and UC Davis Health System) and 18 additional nursing homes in the Sacramento region. Each health system assigns a designated nurse or social worker to work directly and consistently with nursing home staff to improve advance care planning practices and palliative care skills.

The administrator, nursing director and clinical staff in each nursing home received intensive training and support in their facility for the initial six months of participation along with continuing follow-up and support through the remainder of the project. Hospital staff provided mentoring and taught the facilitation of advance care planning conversations. This project was funded by the California HealthCare Foundation.

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ECHO Recommendations

Extreme Care, Humane Options: ECHO Nursing Facility Recommendations
January 2000

The ECHO Nursing Facility Recommendations were designed to improve end-of-life care for nursing home residents by enhancing the advance care planning process and palliative care services. The recommendations clearly focused attention on the resident’s role in the end-of-life decision-making process while ensuring end-of-life care honors resident wishes. The recommendations also proposed changes to administrative and clinical practices that addressed existing barriers to end-of-life care.

The ECHO Recommendations were the foundation for a nursing home end-of-life care training program. As part of the program, leadership teams from throughout California developed and implemented end-of-life care practices for their own facility.

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Promising Practices

Through our Promising Practices initiative, the Coalition for Compassionate Care of California worked with a small group of California nursing facilities that were excelling in some aspect of end-of-life care, to provide technical assistance and mentoring to refine these practices into replicable models that can be adopted by other nursing facilities in the state and nationally. Find out more [PDF] about these models.

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