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Analyses of nursing home residents in hospice care using the minimum data set
Robert J Buchanan1, Maryann Choi, Suojin Wang
1Department of Health Policy and Management, School of Rural Public Health, The Texas A&M University System Health Science Center, College Station, Texas 77843-1266, USA. buchanan@srph.tamu.edu
Objective:
To present comprehensive profiles of residents in hospice care at admission to the nursing home using the Minimum Data Set (MDS).
Design And Setting:
We analysed 40,622 MDS admission assessments for nursing home residents in hospice care. The MDS contains resident-focused data on pain, cognitive patterns, physical function, disease diagnoses, medications, nutrition, and specific treatments received.
Results:
About four in five recently admitted hospice residents had 'do not resuscitate' orders and only 27% had a living will. Over 70% of recently admitted hospice residents experienced pain, with almost one half experiencing daily pain. Over one half of those hospice residents in pain experienced moderate pain and almost one third experienced horrible or excruciating pain. About 57% of recently admitted hospice patients had cancer, 21 % had congestive heart failure, 20% had emphysema/chronic obstructive pulmonary disease, and 18% had depression. About one in two recently admitted hospice residents exhibited at least moderate impairment in cognitive function.
Conclusions:
There is a need to improve pain management, advanced directives, and mental health services for residents dying in nursing homes.