Legal Anxieties and End-of-Life Care in Nursing Homes

In the United States, individuals with serious, chronic physical and mental health problems and difficulties in carrying out activities of daily living have available to them an increasing array of services (e.g., home care, assisted living facilities, adult day care) that allow them to avoid or at least substantially postpone admission into a nursing home. Consequently, the acuity level of persons who do need to enter nursing homes today, because they are not capable of being cared for adequately in home and community-based settings, is considerably more severe than that found among nursing home residents even a short time ago.1 Given the nature of its present resident population, the modern American nursing home in large part may be accurately characterized as a place where many people go to die.2 "The probability that a nursing home will be the site of death increased from. 18.7% in 1986 to 20% by 1993," and "[c]urrent health care trends, including aging of the population and pressures to decrease hospital and home health costs, are likely to promote the use of nursing homes as a site for terminal care."3 "Most who enter a nursing home and stay for more than a few months will die there or after transfer to a hospital. They will not again live at home."4