title: Hospice for nursing home residents: does ownership type matter?
abstract: BACKGROUND
  Currently, more than half of all nursing home residents use hospice at some point. Studies have shown benefits to hospice enrollment for patients; however, the literature on ownership differences in hospice care in general has indicated that for-profit hospices offer a narrower scope of services and employ fewer professional staff. Although nursing home staffing patterns have been shown to be essential to quality of care, the literature has not explored differences in number of patients per staff member for hospice care within nursing homes.
  
  
  METHODS
  We hypothesized that for-profit hospices would have a higher number of patients per staff member for home care workers (HCWs), registered nurses (RNs), and medical social workers (MSWs), and this relationship would be moderated by the proportion of hospice users living in nursing homes. Using data from the National Hospice Survey, a random sampling of all Medicare-certified hospices operating between September 2008 and November 2009, we identified 509 hospices that served individuals living in a nursing home, with 89 hospices having 50% or greater of their clients living in a nursing home.
  
  
  RESULTS
  Adjusted analysis indicated a higher number of patients per staff member for HCWs and RNs among for-profit hospices. Moreover, compared with nonprofit hospices, for-profit hospices with a high proportion of nursing home residents had 36 more patients per HCW (p=0.011) and 24 more patients per RN (p=0.033).
  
  
  CONCLUSIONS
  Staffing is an important indicator of hospice quality, thus our findings may be useful for anticipating potential impacts of the growth in for-profit hospice on nursing home residents.
authors.affiliation: 1 Yale School of Public Health, Yale University , New Haven, Connecticut.
authors.forename: Maureen E
authors.initials: ME
authors.lastname: Canavan
authors.forename: Melissa D
authors.initials: MD
authors.lastname: Aldridge Carlson
authors.forename: Heather L
authors.initials: HL
authors.lastname: Sipsma
authors.forename: Elizabeth H
authors.initials: EH
authors.lastname: Bradley
mesh_terms: D003430:Cross-Sectional Studies; D005260:Female; D017051:Hospice Care / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D009735:Nursing Homes / Q000191:economics*; D010067:Ownership; D010561:Personnel Staffing and Scheduling; D019984:Quality Indicators, Health Care; D014481:United States
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