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Hospice Care in Assisted Living Facilities Versus at Home: Results of a Multisite Cohort Study
Meredith Dougherty1, Pamela S Harris2, Joan Teno3
1Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania.
Objectives:
To compare residents of assisted living facilities receiving hospice with people receiving hospice care at home.
Design:
Electronic health record-based retrospective cohort study.
Setting:
Nonprofit hospices in the Coalition of Hospices Organized to Investigate Comparative Effectiveness network.
Participants:
Individuals admitted to hospice between January 1, 2008, and May 15, 2012 (N = 85,581; 7,451 (8.7%) assisted living facility, 78,130 (91.3%) home).
Measurements:
Hospice length of stay, use of opioids for pain, and site of death.
Results:
The assisted living population was more likely than the home hospice population to have a diagnosis of dementia (23.5% vs 4.7%; odds ratio (OR) = 13.3, 95% confidence interval (CI) = 12.3-14.4; P < .001) and enroll in hospice closer to death (median length of stay 24 vs 29 days). Assisted living residents were less likely to receive opioids for pain (18.1% vs 39.7%; OR = 0.33, 95% CI = 0.29-0.39, P < .001) and less likely to die in an inpatient hospice unit (9.3% vs 16.1%; OR = 0.53, 95% CI = 0.49-0.58, P < .001) or a hospital (1.3% vs 7.6%; OR = 0.16, 95% CI = 0.13-0.19, P < .001).
Conclusion:
Three are several differences between residents of assisted living receiving hospice care and individuals living at home receiving hospice care. A better understanding of these differences could allow hospices to develop guidelines for better coordination of end-of-life care for the assisted living population.
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