Innovations in End-of-Life Care
an international journal of leaders in end-of-life care

St. Joseph's Manor, Compassionate Care Focus
Karin "Teddi" Tomsic, Director of Pastoral Care/Mission
6448 Main Street
Trumbull, CT 06611

St. Joseph's Manor is a nursing home with 297 beds, which serves approximately 375 people annually, and has been providing long-term residential care to the surrounding community since 1960. At St. Joseph's Manor, pain management, the use of advance directives, and the formation of an ethics committee have been in place since the late 1980s. In response to a national report of poor perception of quality of care at the end-of-life in nursing homes, St. Joseph's began a plan of action in 1997 to improve care for their residents at the end of life. They based their plan on what they learned from a series of focus groups and questionnaires filled out by both staff and residents' families. After overcoming some initial defensiveness from staff, the Compassionate Care focus group made institution-wide changes rooted in the concept that everyone who comes into a nursing home is, on some level, beginning to deal with life's final phase.

In creating the interdisciplinary focus group to create the Compassionate Care Focus, leaders at this institution brought together people from a wide of array of disciplines including not only nursing and medical staff, but also chaplains, social workers, house staff, maintenance and kitchen staff. The focus group's first change in end-of-life care practice was to designate the rooms in which residents were facing the very last days of life as "holy ground." They chose an angel as the symbol to indicate this special time, and framed, needlepoint angels were hung on the doors of the rooms where patients were imminently dying. Throughout the entire nursing home, staff changed the bed linens from hospital white to soft mauve jersey, with the idea that this change would make the Manor more "home-like," as the Manor was the last home many residents would know. Staff members have paid increased attention to the needs of the families, who often keep a vigil at the bedside of their loved one during the final days and hours of his or her life. A "Comfort Cart" was designed to carry toiletries, blankets, pillows, books, tapes and a tape recorder for the families to use.

Staff made additional changes to honor the residents who had died. There is a long waiting list of persons wishing to enter St. Joseph's Manor, so when a resident dies, the room is needed immediately for a new person. To help families and staff with this rapid transition, family members gather the most important personal items to take with them on the day of the death, with the assurance that the staff will package the rest of the items for pick-up later in the week. Manor staff members then create a Remembrance Box for the recently deceased resident, which is prominently displayed in the nursing unit for the next two to three weeks. The resident's name and picture are placed in the box, and so, staff members have a way to keep the person's memory close, even though another resident now occupies the bed and room.

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