Hospice use among nursing home and non-nursing home patients.
BACKGROUND
For nursing home patients, hospice use and associated costs have grown dramatically. A better understanding of hospice in all care settings, especially how patients move across settings, is needed to inform debates about appropriateness of use and potential policy reform.


OBJECTIVE
Our aim was to describe characteristics and utilization of hospice among nursing home and non-nursing home patients.


METHODS
Medicare, Medicaid and Minimum Data Set data, 1999-2008, were merged for 3,771 hospice patients aged 65 years and above from a safety net health system. Patients were classified into four groups who received hospice: 1) only in nursing homes; 2) outside of nursing homes; 3) crossover patients utilizing hospice in both settings; and 4) "near-transition" patients who received hospice within 30 days of a nursing home stay.


METHODS
Differences in demographics, hospice diagnoses and length of stay, utilization and costs are presented with descriptive statistics.


RESULTS
Nursing home hospice patients were older, and more likely to be women and to have dementia (p < 0.0001). Nearly one-third (32.3 %) of crossover patients had hospice stays > 6 months, compared with the other groups (16 % of nursing home hospice only, 10.7 % of non-nursing home hospice and 7.6 % of those with near transitions) (p < 0.0001). Overall, 27.7 % of patients had a hospice stay <1 week, but there were marked differences between groups-48 % of near-transition patients vs. 7.4 % of crossover patients had these short hospice stays (p < 0.0001). Crossover and near-transition hospice patients had higher costs to Medicare compared to other groups (p < 0.05).


CONCLUSIONS
Dichotomizing hospice users only into nursing home vs. non-nursing home patients is difficult, due to transitions across settings. Hospice patients with transitions accrue higher costs. The impact of changes to the hospice benefit on patients who live or move through nursing homes near the end of life should be carefully considered.
Indiana University Center for Aging Research, 410 West 10th Street, Suite 2000, Indianapolis, IN, 46202, USA, kunroe@iu.edu.
Kathleen T
KT
Unroe
Greg A
GA
Sachs
M E
ME
Dennis
Susan E
SE
Hickman
Timothy E
TE
Stump
Wanzhu
W
Tu
Christopher M
CM
Callahan
D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D018592:Cross-Over Studies; D005260:Female; D005500:Follow-Up Studies; D006301:Health Services Needs and Demand / Q000191:economics; D017051:Hospice Care / Q000191:economics / Q000706:statistics & numerical data*; D006738:Hospices / Q000191:economics / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D008484:Medicaid; D006278:Medicare / Q000191:economics; D009735:Nursing Homes / Q000191:economics; D014481:United States / Q000453:epidemiology