End-of-Life Care in Assisted Living Facilities

Terminally ill residents, their families, and care providers were interviewed and observed in 4 assisted living facilities (ALFs). Families supported the residents’ desires to die “at home,” and dying residents had sustained, caring relationships with some staff. Facilities varied in terms of the services they could provide at the end of life. The staff did not always have sufficient training in care at the end of life, and staffing ratios did not always accommodate the intense care needs of dying people. ALF and hospice staffs did not plan, coordinate, or communicate sufficiently in providing care services. This study suggests that the privacy and autonomy that make ALFs desirable living environments may create challenges when dying residents require increasingly intense monitoring and care.