Families' perception of the added value of hospice in the nursing home.
OBJECTIVE
To determine if family members perceive that hospice improves the care of dying nursing home residents during the last 3 months of life.


METHODS
Mailed survey.


METHODS
Family members for all nursing home hospice enrollees in North Carolina during a 6-month period.


METHODS
After residents' deaths, family members answered questions about the quality of care for symptoms before and after hospice, the added value of hospice, the effect of hospice on hospitalization, and special services provided by nursing home staff or by hospice staff.


RESULTS
A total of 292 (73%) of 398 eligible family members completed surveys. The average age of the nursing home residents who had received hospice was 79.5 years; 50% had cancer and 76% were dependent for self-care. In their last 3 months, 70% of decedents had severe or moderate pain, 56% had severe or moderate dyspnea, and 61% had other symptoms. Quality of care for physical symptoms was rated good or excellent by 64% of family before hospice and 93% after hospice (P<.001). Dying residents' emotional needs included care for moderate or severe depression (47%), anxiety (50%), and loneliness (35%). Quality of care for emotional needs was rated good or excellent by 64% of family before hospice and 90% after hospice (P<.001). Fifty-three percent of respondents believed hospice prevented hospitalizations. Family estimated the median added value of hospice to be $75 per day and described distinct special services provided by hospice and by nursing home staff.


CONCLUSIONS
Family members believe that nursing home hospice improves quality of care for symptoms, reduces hospitalizations, and adds value and services for dying nursing home residents.
Baer
W M
WM
Division of General Medicine, School of Medicine, University of North Carolina, Chapel Hill 27599-7110, USA.
Hanson
L C
LC
D000203:Activities of Daily Living; D000368:Aged; D001294:Attitude to Health; D003362:Cost-Benefit Analysis; D005190:Family / Q000523:psychology*; D006302:Health Services Research; D006701:Home Nursing / Q000191:economics / Q000592:standards*; D006738:Hospices / Q000191:economics / Q000592:standards*; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data; D020380:Needs Assessment; D009657:North Carolina; D011787:Quality of Health Care; D011795:Surveys and Questionnaires