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Hospice use among nursing home patients
Kathleen Tschantz Unroe1, Greg A Sachs, Susan E Hickman
1Indiana University Center for Aging Research, Indianapolis, IN 46202, USA. kunroe@iupui.edu
Journal of the American Medical Directors Association
|November 28, 2012
Summary
Hospice use in nursing homes is increasing, with many patients having long stays and multiple health issues. Predicting clinical course and supporting varied care delivery are crucial for policy. Keywords: hospice, nursing homes, palliative care.
Area of Science:
- Gerontology
- Palliative Care
- Health Services Research
Background:
- Hospice care is increasingly utilized by nursing home residents.
- Understanding trends and patterns in this population is essential for quality care.
Purpose of the Study:
- To analyze trends in hospice use among nursing home residents.
- To identify factors associated with prolonged hospice stays (>6 months).
- To describe hospice utilization patterns in this demographic.
Main Methods:
- Retrospective study of Medicare and Medicaid claims, and Minimum Data Set assessments.
- Analysis of 1452 hospice patients aged ≥65 residing in nursing homes (1999-2008).
- Logistic regression used to model factors associated with hospice stays >6 months.
Main Results:
- Non-cancer diagnoses increased over time; mean hospice stay was 114 days.
- Nearly 20% of patients had hospice stays >6 months, with lower cancer prevalence.
- Longer stays were associated with higher disenrollment rates before death (33.9% vs 13.8%).
Conclusions:
- Predicting clinical trajectories in nursing home hospice patients is challenging.
- Varied utilization patterns and transitions across settings require consideration.
- Policy should support diverse palliative care delivery models in nursing homes.
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