Intensifying Relational Care: The Challenge of Dying in Long-Term Residential Care

Abstract

Although the culture change movement has sought to transform residential care facilities from warehouses of death into homes for living, there is growing recognition of the need to address dying within these settings. Drawing on data from an international and interdisciplinary study, this paper explores the state of end-of-life care in residential care facilities, identifying barriers to the provision of compassionate care for the dying, as well as promising practices and areas for future inquiry. Interviews with staff and researcher observations at 20 nursing homes in Canada, Germany, Norway, Sweden, the United States, and the United Kingdom were analyzed. Six themes were identified: the growing need for end-of-life care; the challenge of identifying a dying phase; the importance of open communication about death; the need to address bereavement of both families and staff; the need for additional training and resources; and the inadequacy of current models of care. Taken together, these findings suggest that dying intensifies the need for relational care, a type of care residential care facilities have been struggling to provide. However, while demands increase, there are also opportunities. We conclude with a reflection on the potential that the blurred boundaries between living and dying hold for experimentation in long-term residential care with visions of life and health that can include death.