title: Hospice Care in Assisted Living Facilities Versus at Home: Results of a Multisite Cohort Study.
abstract: OBJECTIVE
  To compare residents of assisted living facilities receiving hospice with people receiving hospice care at home.
  
  
  METHODS
  Electronic health record-based retrospective cohort study.
  
  
  METHODS
  Nonprofit hospices in the Coalition of Hospices Organized to Investigate Comparative Effectiveness network.
  
  
  METHODS
  Individuals admitted to hospice between January 1, 2008, and May 15, 2012 (N = 85,581; 7,451 (8.7%) assisted living facility, 78,130 (91.3%) home).
  
  
  METHODS
  Hospice length of stay, use of opioids for pain, and site of death.
  
  
  RESULTS
  The assisted living population was more likely than the home hospice population to have a diagnosis of dementia (23.5% vs 4.7%; odds ratio (OR) = 13.3, 95% confidence interval (CI) = 12.3-14.4; P < .001) and enroll in hospice closer to death (median length of stay 24 vs 29 days). Assisted living residents were less likely to receive opioids for pain (18.1% vs 39.7%; OR = 0.33, 95% CI = 0.29-0.39, P < .001) and less likely to die in an inpatient hospice unit (9.3% vs 16.1%; OR = 0.53, 95% CI = 0.49-0.58, P < .001) or a hospital (1.3% vs 7.6%; OR = 0.16, 95% CI = 0.13-0.19, P < .001).
  
  
  CONCLUSIONS
  Three are several differences between residents of assisted living receiving hospice care and individuals living at home receiving hospice care. A better understanding of these differences could allow hospices to develop guidelines for better coordination of end-of-life care for the assisted living population.
authors.affiliation: Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania.
authors.forename: Meredith
authors.initials: M
authors.lastname: Dougherty
authors.affiliation: Kansas City Hospice and Palliative Care, Kansas City, Missouri.
authors.forename: Pamela S
authors.initials: PS
authors.lastname: Harris
authors.affiliation: Warren Alpert School of Medicine, Brown University, Providence, Rhode Island.
authors.forename: Joan
authors.initials: J
authors.lastname: Teno
authors.affiliation: Milton S. Hershey Medical Center, College of Medicine, Penn State University, Hershey, Pennsylvania.
authors.forename: Amy M
authors.initials: AM
authors.lastname: Corcoran
authors.affiliation: Faith Presbyterian Hospice, Dallas, Texas.
authors.forename: Cindy
authors.initials: C
authors.lastname: Douglas
authors.affiliation: Arbor Hospice, Ann Arbor, Michigan.
authors.forename: Jackie
authors.initials: J
authors.lastname: Nelson
authors.affiliation: Philadelphia Veterans Affairs Medical Center, Philadelphia, Pennsylvania.
authors.forename: Deborah
authors.initials: D
authors.lastname: Way
authors.affiliation: Hospice and Community Care, Lancaster, Pennsylvania.
authors.forename: Joan E
authors.initials: JE
authors.lastname: Harrold
authors.affiliation: Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania.
authors.forename: David J
authors.initials: DJ
authors.lastname: Casarett
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D040561:Assisted Living Facilities / Q000458:organization & administration*; D015331:Cohort Studies; D005260:Female; D015577:Geriatric Assessment / Q000706:statistics & numerical data; D006304:Health Status; D006699:Home Care Services / Q000458:organization & administration*; D017051:Hospice Care / Q000592:standards* / Q000706:statistics & numerical data*; D006738:Hospices / Q000706:statistics & numerical data; D006801:Humans; D057187:Independent Living / Q000706:statistics & numerical data*; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D012189:Retrospective Studies; D014481:United States / Q000453:epidemiology
keywords: assisted living; hospice; palliative care