The Effect of Hospice on Hospitalizations of Nursing Home Residents

Abstract

Objectives Hospice enrollment is known to reduce risk of hospitalizations for nursing home residents who use it. We examined whether residing in facilities with a higher hospice penetration: 1) reduces hospitalization risk for non-hospice residents; and 2) decreases hospice-enrolled residents’ hospitalization risk relative to hospice-enrolled residents in facilities with a lower hospice penetration. Method Medicare Beneficiary File, Inpatient and Hospice Claims, Minimum Data Set Version 2.0, Provider of Services File and Area Resource File. Retrospective analysis of long-stay nursing home residents who died during 2005-2007. Overall, 505,851 non-hospice (67.66%) and 241,790 hospice-enrolled (32.34%) residents in 14,030 facilities nationwide were included. We fit models predicting the probability of hospitalization conditional on hospice penetration and resident and facility characteristics. We used instrumental variable method to address the potential endogeneity between hospice penetration and hospitalization. Distance between each nursing home and the closest hospice was the instrumental variable. Main Findings In the last 30 days of life, 37.63% of non-hospice and 23.18% of hospice residents were hospitalized. Every 10% increase in hospice penetration leads to a reduction in hospitalization risk of 5.1% for non-hospice residents and 4.8% for hospice-enrolled residents. Principal Conclusions Higher facility-level hospice penetration reduces hospitalization risk for both non-hospice and hospice-enrolled residents. The findings shed light on nursing home end-of-life care delivery, collaboration among providers and cost benefit analysis of hospice care.

Palliative Care Consultations in Nursing Homes and End-of-Life Hospitalizations

“…Introduction of consults likely reflects a greater NH emphasis on palliative care, and an increased resident and staff exposure to palliative care expertise. However, unlike Zheng and colleagues (17), we did not observe an increase in exposure (i.e., a greater visit volume) to be associated with reduced hospitalizations even when in sensitivity analysis we tested the visit volume using a categorical variable with differing cutoffs. Our finding of no effect is probably related to the relatively small volume of NH palliative care consult recipients/visits compared to the volume of hospice care (17).…”

“…However, unlike Zheng and colleagues (17), we did not observe an increase in exposure (i.e., a greater visit volume) to be associated with reduced hospitalizations even when in sensitivity analysis we tested the visit volume using a categorical variable with differing cutoffs. Our finding of no effect is probably related to the relatively small volume of NH palliative care consult recipients/visits compared to the volume of hospice care (17). Resident-level analyses (in NHs offering specialty consults), has shown 10% of decedents received consults in their last six months of life (14, 15); in contrast, 28% of Medicare beneficiaries dying in NHs received hospice (in 2005–2007) (17).…”

“…In related research, NH hospitalization rates for dying residents with and without hospice are observed to be lower when a NH’s hospice use is higher. (16, 17)…”

Nursing Home Staff Palliative Care Knowledge and Practices: Results of a Large Survey of Frontline Workers

“…NHs with higher hospice market penetration have been found to provide higher quality end-of-life care to all patients; some have hypothesized that this is a result of diffusion of knowledge from hospice providers. 27 …”

Improving the Quality of End-of-Life Care

“…5 Hospice residents were rehospitalized 23.18% compared with 37.63% of nonhospice residents. 6 Advance care planning and advanced directives need to be discussed early. The INTERACT program has reduced hospital admissions predominantly by obtaining advanced directive planning that includes the decision not to be rehospitalized.…”