title: End-of-life care in U.S. nursing homes: nursing homes with special programs and trained staff for hospice or palliative/end-of-life care.
abstract: BACKGROUND
  The degree to which nursing homes have internal programs for hospice and palliative care is unknown. We used self-reported data from the 2004 National Nursing Home Survey (NNHS) to estimate the prevalence of special programs and (specially) trained staff (SPTS) for hospice or palliative/end-of-life care in U.S. nursing homes. Factors associated with the presence of SPTS for hospice or palliative/end-of-life care were identified.
  
  
  METHODS
  We merged 2004 NNHS data for 1174 nursing homes to county-level data from the 2004 Area Resource File and to Nursing Home 2004 Online Survey, Certification, and Reporting data. chi(2) tests and logistic regression models were applied.
  
  
  RESULTS
  Twenty-seven percent of U.S. nursing homes reported (internal) SPTS for hospice or palliative/end-of-life care. After controlling for covariates, we found nonprofit status, being in the southern region of the United States, having an administrator certified by the American College of Health Care Administrators, contracting with an outside hospice provider, and having other specialty programs to be associated with a greater likelihood of nursing homes having SPTS for hospice or palliative/end-of-life care. The largest effects were observed for nursing homes with programs for behavioral problems (adjusted odds ratio [AOR] 3.59; 95% confidence interval [CI] 2.40, 5.37) and for pain management (AOR 5.92; 95% CI 4.09, 8.57).
  
  
  CONCLUSIONS
  The presence of internal SPTS for hospice or palliative/end-of-life care is prevalent in U.S. nursing homes, and may be preceded by hospice contracting and/or the implementation of specialty programs that assist nursing homes in developing the expertise needed to establish their own palliative care programs.
authors: Center for Gerontology and Health Care Research, The Warren Alpert Medical School of Brown University, Providence, Rhode Island 02912, USA. Susan_Miller@brown.edu
authors: Susan C
authors: SC
authors: Miller
authors: Beth
authors: B
authors: Han
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D016009:Chi-Square Distribution; D019538:Health Care Surveys; D006282:Health Personnel / Q000193:education; D017051:Hospice Care / Q000458:organization & administration / Q000706:statistics & numerical data; D006801:Humans; D016015:Logistic Models; D006278:Medicare; D009735:Nursing Homes / Q000458:organization & administration* / Q000706:statistics & numerical data; D010166:Palliative Care / Q000458:organization & administration* / Q000706:statistics & numerical data; D011787:Quality of Health Care; D013727:Terminal Care; D014481:United States