The importance of leadership in creating good deaths in LTC

Here’s my latest article on McKnight’s Long-Term Care News:


The importance of leadership in creating good deaths in LTC

In one of the more disturbing encounters I’ve had in long-term care — in a 5-Star deficiency-free nursing home — I offered my condolences to an aide on the loss of a resident she’d cared for over a period of two years.

The aide, a heavyset woman, smiled as she told me that she’d known the resident was dying and had urged the nurse to send her to the hospital quickly. The reason? She didn’t want to wrap the body of the equally heavyset resident after she died.

The resident died among strangers in an ambulance on the way to the hospital.

While I’d like to think the incident was an anomaly, I suspect many if not most nursing homes lack a mission statement for end-of-life care and that most teams can be better prepared for the last months and days of their residents.

Without leadership and training, disorganization and staff priorities can derail the care philosophy of the facility.

Providing decent end-of-life care is more than determining if a resident is DNR or full code. It includes recognizing that someone may be nearing the end of life, referring him or her to hospice while they’re most able to benefit from it, communicating regularly with the resident and their family about their needs, and treating the dying person, their remains and their belongings with respect.

Impact on families

Incidents such as the one above reflect poorly on the organization, even if family members don’t realize that it could have been averted with proper staff training. We often hear how important it is to make a good first impression, but as community institutions relying on reputation and referrals, it’s also essential to make a good last impression.

I’ve heard family members comment that they hadn’t always been pleased with the care at the home but they felt that their mother’s death had been handled with great respect. They left with a feeling of overall satisfaction.

Other families had been reasonably satisfied all along, but departed from the facility in shocked dismay at the end of their parent’s life at the poor communication, insufficient pain management and casual disregard for the belongings of the deceased.

Resident impact

Residents are closely observing how their neighbors’ deaths are handled because they know that this is how they will be treated when their time comes. Based on my experience, the things they find most disturbing are inadequate pain management, unacknowledged deaths and seeing the belongings of their friends removed in clear plastic garbage bags rather than in labeled boxes. They find it most comforting when they see that patients are referred to hospice, surrounded by loved ones, sleeping calmly through the night and when there’s a discussion of the loss among the residents, staff and chaplaincy.

Staff impact

The ways in which facilities handle deaths can have a big impact on staff members as well. As I suggest in “Absenteeism and turnover? Death anxiety could be the cause,” lack of attention to the experience of staff members in handling loss can contribute to employee turnover.

For the entire article, visit:

The importance of leadership in creating good deaths in LTC

Aging Insider Article

3 thoughts on “The importance of leadership in creating good deaths in LTC”

  1. So…is this a criticism of whats seen as callous disregard by staff? The LTC facilities you describe always sound well staffed and amply resourced, or there seems to be time to pursue emotional concern. There is a popular growing trend in many other parts of the country where distant corporations are purchasing LTC homes. Their distal impersonal management encourages a pursuit for maximum profit, this resulting in at least staff reduction and often cheap supplies. The hands on staff barely have time for shift priorities and need to observe them if they want to keep their jobs and help support their own families. They appreciate the families offering spiritual and emotional support with dying residents. Sadly if there is no available support the resident often takes their last breath alone. Hospice staff too works according to schedule. They are not typically hand holders. I wish Mcknight’s News would sometimes comment on the daily operations and conditions occuring within these micro managed LTC facilities as they are a prevailing norm.

    • Thanks for your thoughts, ImogenePillsbury. I wrote the piece to increase the recognition of the importance of these aspects of long-term care. I realize that facilities aren’t going to follow all my suggestions, but if a few places decide to use boxes rather than garbage bags for the belongings of the deceased or decide to improve the hospice referral process, that would be an improvement. As an individual, I can’t fix the dysfunctional healthcare system but perhaps I can offer some aspirational guidance that results in positive change.

      • Thanks for responding. For yrs I have worked in and so gathered an opinion of long term care in some midwestern facilities. Again, I’m noticing the increasing corporate ownership is not resulting in improvement but rather stressed environments, decreased staff and substandard care. We had a death a few nights ago, and, though we did try to make the conditions more optimal, this 85yr. old woman did indeed pass in her bed and alone.


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