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Oregon Road Conditions & Cams Advertisement Email Story to a Friend March 6, 2005 End-of-life study targets challenge of ‘good death’ By BILL KETTLER Mail Tribune An Ashland nurse-educator will study end-of-life care in assisted-living centers. Juliana Cartwright will talk with nurses and caregivers to learn what works — and what doesn’t — when people spend their final days in assisted living. Assisted-living arrangements have gained popularity among older people who can no longer manage all the activities of daily living on their own, but don’t need the medical care of a nursing home. Assisted-living centers provide meals and housekeeping for residents, but they plan their own day-to-day activities. Cartwright is a professor of nursing at Oregon Health & Science University School of Nursing at Southern Oregon University in Ashland. She said assisted-living centers face many of the same issues that confront nursing homes and other care centers where patients die. Caregivers need to know how to manage pain, maximize patient comfort and counsel those who may be depressed by fatal illness. Cartwright said the study is needed because assisted living is the fastest-growing residential care option in the United States, and many residents who face a fatal illness want to live out their days in the place that has become their home. Advertisement "They feel attached to the staff," she said. "They’ve become like family." Problems sometimes surface, she said, when hospice nurses and assisted-living care-givers share responsibility for a dying patient. Hospice nurses make frequent visits to dying patients, but assisted-living staff may spend much more time with them. She noted that 28 percent of the annual turnover in assisted living centers comes from residents who die, and that assisted living is the second most frequent setting for hospice care. She said Oregon is an "ideal" place to conduct her research because the state has been a pioneer in developing the assisted-living concept. KerenBrown Wilson developed the first assisted-living center in Oregon in the early 1980s, and assisted living has become a key element of the state’s "aging in place" policy, which is designed to give older people as much autonomy as they can manage. Assisted living continues to gain adherents as Oregon’s population ages. The number of Oregonians in assisted living nearly doubled between 1998 and 2002, when there were almost 12,000 people in an assisted-living arrangement. "In Oregon, more older adults live in assisted living than in nursing homes," she said. There are 626 licensed assisted-living units in Jackson County and 364 in Josephine County. Cartwright will interview 50 nurses and caregivers at assisted living centers in Portland and in rural areas such as Klamath Falls and Brookings. She chose not to include assisted-living centers in Jackson County because she wanted to compare end-of-life care in truly rural settings with care that’s available in a large urban center. Jackson County, she noted, is such a mixture of urban and rural at this point that local assisted-living centers did not meet the "rural’ criteria for her study. She’ll ask caregivers to talk about how they manage terminal patients’ pain as well as other aspects of end-of-life care, such the constipation, dry mouth and labored breathing that often accompany a final illness. Cartwright’s research is funded with a grant from the National Institute for Nursing Research, an affiliate of the National Institutes of Health. Her findings should be published during summer 2006. "We need to understand the challenges of making a ‘good death’ happen in these settings," she said. "The facilities are supportive. It’s just a matter of learning how to make it work." Mail Tribune Home | Local News | Sports | Business | Obituaries | Life | Opinion AP News | Archives | Site Map | Community | Classified Copyright © 1997-2006 Mail Tribune, Inc. All rights reserved. Privacy Policy | Terms & Conditions | Website Feedback www.bingo.com Home Security Systems Trunks, Footlocker Custom Build Computers Discount Hotel Reservations online casinos news Ashley Furniture HomeStore Send Flowers Southern Oregon Loans California Casinos GMAT Prep Windermere Van Vleet Sports Equipment Online Casino Reviews Online Bingo Entertainment Guide Online Casino Fundraisers Sudoku Online Casinos Canada Online Pharmacy Advertisement s