The number of nursing home residents in the United States continues to grow annually, as does the number of individuals who die in this long-term care setting. The end-of-life experience for nursing home residents, their families, and health care professionals can be improved with greater access to hospice programs. Based on the percentage of residents who use hospice before death and the duration of use, hospice services are underutilized by nursing home residents. In this article, the benefits and challenges of providing hospice care to nursing home residents and their family members are reviewed. (Annals of Long-Term Care: Clinical Care and Aging 2005;13[10]:25-29)

Clinicians deal with persons from more than 100 different ethnic groups in the United States—some with language barriers, and some from a culture of poverty. Being a minority in any institution is potentially stressful and can lead to disparities in care and understanding. External health locus of control and different “help-seeking behavior patterns” are common issues with minority nursing home residents, which are best addressed through health education and open communication. A checklist for culturally sensitive care is provided in this article to help improve recognition of potential cultural barriers and highlight methods that might improve the cultural fit for the nursing home resident. (Annals of Long-Term Care: Clinical Care and Aging 2005;13[10]: 18-24)

In June 2005, the Centers for Medicare & Medicaid Services (CMS) released its revised regulations for nursing facility medical directors and guidance to state surveyors regarding enforcement of these regulations. This article describes the revised regulations and provides historical background on the role of the medical director. The role of federal regulation as a strategy to improve the quality of medical direction within U.S. nursing facilities is discussed. Suggestions for the medical director’s response to the revised regulations are included. The article concludes with the observation that although regulations may be necessary, they are insufficient alone to achieve the desired goal of quality medical care for every nursing home resident. (Annals of Long-Term Care: Clinical Care and Aging 2005;13[10]:43-46)