End-of-life care in nursing homes: residents in hospice compared to other end-stage residents.
OBJECTIVE
To compare residents in hospice care at admission to the nursing facility to end stage residents not in hospice at admission.


METHODS
We analyzed 18,211 admission assessments recorded in the Minimum Data Set (MDS) during the year 2000 throughout the United States for residents classified as having an end-stage disease (6 or fewer months to live). Fifty-nine percent (n = 10,656) of these residents were in hospice care at the time of their admission assessment. We used these MDS admission assessments to compare residents in hospice care to other end-stage residents not in hospice for demographic characteristics, health status, and treatments.


RESULTS
Hospice residents at admission were significantly more likely to be female, older, white, and widowed than other end-stage residents at admission. There were significant differences between hospice residents and other residents at end stage in the use of advanced directives at admission. Hospice residents at admission experienced significantly more frequent and more intense pain than other end-stage residents at admission, while these hospice residents also showed greater impairment in cognitive ability and physical function. While cancer was the most common disease among these end-stage residents, it was significantly more prevalent among hospice residents.


CONCLUSIONS
Many end-stage residents may not be receiving adequate palliative care in nursing facilities; further study of this is warranted. The MDS should be revised to record minimum standards for palliative care with or without the use of hospice to improve end-of life care in nursing facilities.
Buchanan
Robert J
RJ
College of Health and Human Services, The University of North Carolina at Charlotte, Charlotte, North Carolina 28223, USA. RJBuchan@emailuncc.edu
Choi
Maryann
M
Wang
Suojin
S
Ju
Hyunsu
H
D000203:Activities of Daily Living; D000328:Adult; D016223:Advance Directives; D000368:Aged; D000369:Aged, 80 and over; D003710:Demography; D005260:Female; D019538:Health Care Surveys; D006738:Hospices / Q000592:standards* / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D008875:Middle Aged; D009730:Nursing Assessment; D009735:Nursing Homes / Q000458:organization & administration* / Q000706:statistics & numerical data; D010146:Pain / Q000188:drug therapy / Q000453:epidemiology; D010166:Palliative Care / Q000706:statistics & numerical data; D010343:Patient Admission / Q000706:statistics & numerical data; D013727:Terminal Care / Q000592:standards* / Q000706:statistics & numerical data; D014481:United States / Q000453:epidemiology