Skilled Nursing Facility Assessment Tool

Co-created by Jane Whitlock, Catherine Thiemann, and Patty Brennan

How does your facility support residents and loved ones who are dying?

• How does your care change once residents are on hospice?
• How do staff members know which residents are on hospice?
• Do you educate residents and their families about end-of-life issues and the dying process? Who is responsible for this?
• How do you support grieving staff members? Who does this?
• How do you support residents after a death?
• Do you offer a send-off ritual after a resident’s death?
• Do you maintain a public memorial space?
• Do you educate residents and families on the realities of CPR for people with their health status? How many of your residents are “full code”?
• Do physicians and nurses routinely check POLST orders before doing CPR, tracheal tubes, feeding tubes, hospitalization, or other medical interventions? (NOTE: Medical caregivers are mandated to check orders by state regulations. Further, any changes in the patient’s condition may trigger a mandatory review and update of their POLST.)
• For patients on hospice, are staff members encouraged to call the hospice team when medical questions arise?
• Have you checked in with your hospice teams to learn what problems they typically encounter when coordinating with staff at your facility?
• Are comfort medications administered on schedule, PRN, or both?

How does the facility help healthy residents prepare for death?

• Do you have a “Living Well, Dying Well” discussion group for residents?
• Do you support residents in preparing Advance Directives?

How does the facility work with end-of-life doulas?

• Have you ever had an end-of-life doula on staff? What were the positives and negatives in the opinion of staff members?
• Did the board invite staff leaders’ thoughts about the need for an end-of-life doula?
• Do staff members support having an end-of-life doula on board?
• Are end-of-life doulas expected or encouraged to chart, work specific hours, or visit a certain number of residents per day?
• To what extent is the doula expected to be available outside of their regular hours?
• To what extent may the doula set their own work schedule and tasks?
• Are patients’ pain management orders shared with the doula?
• May the doula contact hospice directly if the patient shows symptoms of distress?
• May the doula communicate patient care needs with the patient’s nurse directly?

Download this tool as PDF.