Hospice Use Among Nursing Home and Non-Nursing Home Patients

Abstract

BACKGROUND:For nursing home patients, hospice use and associated costs have grown dramatically. A better understanding of hospice in all care settings, especially how patients move across settings, is needed to inform debates about appropriateness of use and potential policy reform. OBJECTIVE: Our aim was to describe characteristics and utilization of hospice among nursing home and nonnursing home patients. DESIGN AND PARTICIPANTS: Medicare, Medicaid and Minimum Data Set data, 1999-2008, were merged for 3,771 hospice patients aged 65 years and above from a safety net health system. Patients were classified into four groups who received hospice: 1) only in nursing homes; 2) outside of nursing homes; 3) crossover patients utilizing hospice in both settings; and 4) "near-transition" patients who received hospice within 30 days of a nursing home stay. MAIN MEASURES: Differences in demographics, hospice diagnoses and length of stay, utilization and costs are presented with descriptive statistics. KEY RESULTS: Nursing home hospice patients were older, and more likely to be women and to have dementia (p<0.0001). Nearly one-third (32.3 %) of crossover patients had hospice stays > 6 months, compared with the other groups (16 % of nursing home hospice only, 10.7 % of nonnursing home hospice and 7.6 % of those with near transitions) (p<0.0001). Overall, 27.7 % of patients had a hospice stay <1 week, but there were marked differences between groups-48 % of near-transition patients vs. 7.4 % of crossover patients had these short hospice stays (p<0.0001). Crossover and near-transition hospice patients had higher costs to Medicare compared to other groups (p<0.05). CONCLUSIONS: Dichotomizing hospice users only into nursing home vs. non-nursing home patients is difficult, due to transitions across settings. Hospice patients with transitions accrue higher costs. The impact of changes to the hospice benefit on patients who live or move through nursing homes near the end of life should be carefully considered.

Transitions Between Healthcare Settings of Hospice Enrollees at the End of Life

“…Despite important concerns about fragmentation in care at the end of life, little is known about the number and types of transitions that hospice users experience before death. A small number of studies have examined this issue . One study found that 6% of individuals with lung or colorectal cancer were admitted to the hospital at least once after hospice enrollment .…”

“…Two studies reported hospitalization and hospice disenrollment of Medicare hospice users with cancer and heart failure . A recent study analyzed Medicare, Medicaid, and Minimum Data Set data from a single safety net healthcare system and found that 9.9% of 3,771 hospice users were hospitalized during or after hospice . These studies were limited to specific populations or settings and focused on transitions from hospice to hospital.…”

Effect of Hospice Use on Costs of Care for Long‐Stay Nursing Home Decedents

“…In addition, the data were collected over 11 years, during which time use of hospice by NH residents changed, including overall growth and increase of noncancer hospice diagnoses. Nevertheless, prior work with this data set showed that trends over time in this sample largely mirrored those of national NH samples . Finally, without the ability to incorporate measures of care quality for people with and without hospice services in this data set, the value of such care cannot be commented on directly.…”

Impact of Wireless Communications Technologies on Elder People Healthcare: Smart Home in Australia

“…The ageing population is growing rapidly in numbers and most older people must at some point select a nursing home as a basic healthcare solution [6]. Generally, this health care method incurs high expenditure, affecting the quality of life of the patient, limiting family visits and exposes older people to often unacceptable behavior and lack of respect by nursing home staff [7].…”