title: Hospice use and public expenditures at the end of life in assisted living residents in a Florida Medicaid waiver program.
abstract: OBJECTIVE
  To examine the association between hospice use and public expenditures in a sample of dually eligible assisted living (AL) residents at the end of life.
  
  
  METHODS
  A retrospective cohort study.
  
  
  METHODS
  Florida AL facilities.
  
  
  METHODS
  Newly enrolled dually eligible older AL residents under Florida's Medicaid Assisted Living for the Elderly waiver program who died between January 2003 and December 2004 (N = 382).
  
  
  METHODS
  Individual sociodemographic characteristics were obtained from Florida's Medicaid comprehensive assessment data. Medicaid eligibility status, enrollment in the AL waiver programs, International Classification of Diseases, Ninth Revision, Clinical Modification, codes and Medicaid claims data were obtained from Florida's Medicaid payment agency. Individual characteristics and Medicare and Medicaid claims data were merged with vital statistics to determine diagnoses, date of death, hospice enrollment, and public expenditures.
  
  
  RESULTS
  The mean age of the study sample was 84.8 (range 65-102); 71.5% were female, and 63.4% were white. During the average 9.6 months of follow-up, 35.6% of the sample enrolled in hospice, and the average hospice length of stay was 47.9 d; 73.3% of the sample had been admitted to a hospital, and 38.0% had been admitted to a nursing home. The generalized linear model showed that hospice use was not significantly associated with lower public expenditures (average marginal effect = -$1,127, 95% confidence interval = -$8,377, $6,122).
  
  
  CONCLUSIONS
  Hospice use at the end of life may not be associated with lower public expenditures in older dually eligible AL residents. Future research should examine the association between hospice enrollment and the quality of end-of-life care.
authors.affiliation: School of Aging Studies, University of South Florida, Tampa, Florida; Florida Policy Exchange Center on Aging, University of South Florida, Tampa, Florida.
authors.forename: Hongdao
authors.initials: H
authors.lastname: Meng
authors.forename: Debra
authors.initials: D
authors.lastname: Dobbs
authors.forename: Su
authors.initials: S
authors.lastname: Wang
authors.forename: Kathryn
authors.initials: K
authors.lastname: Hyer
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D040561:Assisted Living Facilities / Q000191:economics*; D004608:Eligibility Determination; D005260:Female; D005431:Florida; D005500:Follow-Up Studies; D006699:Home Care Services / Q000191:economics*; D017051:Hospice Care / Q000191:economics* / Q000706:statistics & numerical data; D006738:Hospices / Q000191:economics*; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D008484:Medicaid / Q000706:statistics & numerical data*; D006278:Medicare / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D013727:Terminal Care / Q000191:economics / Q000379:methods*; D014481:United States
keywords: Medicaid; Medicare; end of life; expenditures