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Hospice Use Among Nursing Home and Non-Nursing Home Patients

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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 non-nursing 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 non-nursing 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.

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Acknowledgements

The work is supported by NPCRC grant #4183655, NIA grant RO1 AG031222 and K24 AG024078. All authors were involved in the analysis, writing and editing of this manuscript. There are no other contributors to acknowledge.

Conflict of Interest

The authors declare that they do not have a conflict of interest.

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Authors and Affiliations

  1. Indiana University Center for Aging Research, 410 West 10th Street, Suite 2000, Indianapolis, IN, 46202, USA

    Kathleen T. Unroe MD, MHA, Greg A. Sachs MD, Wanzhu Tu PhD & Christopher M. Callahan MD

  2. Regenstrief Institute, Inc., Indianapolis, IN, USA

    Kathleen T. Unroe MD, MHA, Greg A. Sachs MD, M. E. Dennis BA, Wanzhu Tu PhD & Christopher M. Callahan MD

  3. Indiana University School of Medicine, Indianapolis, IN, USA

    Kathleen T. Unroe MD, MHA, Greg A. Sachs MD, Timothy E. Stump MA & Christopher M. Callahan MD

  4. Indiana University School of Nursing, Indianapolis, IN, USA

    Susan E. Hickman PhD

  5. RESPECT Signature Center at IUPUI, Indianapolis, IN, USA

    Kathleen T. Unroe MD, MHA, Greg A. Sachs MD & Susan E. Hickman PhD

Authors
  1. Kathleen T. Unroe MD, MHA
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  2. Greg A. Sachs MD
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  6. Wanzhu Tu PhD
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  7. Christopher M. Callahan MD
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Corresponding author

Correspondence to Kathleen T. Unroe MD, MHA.

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Unroe, K.T., Sachs, G.A., Dennis, M.E. et al. Hospice Use Among Nursing Home and Non-Nursing Home Patients. J GEN INTERN MED 30, 193–198 (2015). https://doi.org/10.1007/s11606-014-3080-x

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  • DOI: https://doi.org/10.1007/s11606-014-3080-x

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