title: Effect of Hospice Use on Costs of Care for Long-Stay Nursing Home Decedents.
abstract: OBJECTIVE
  To analyze the costs for long-stay (>90 days) nursing home (NH) decedents with and without hospice care.
  
  
  METHODS
  Retrospective cohort study using a 1999-2009 data set of linked Medicare and Medicaid claims and minimum data set (MDS) assessments.
  
  
  METHODS
  Indiana NHs.
  
  
  METHODS
  Long-stay NH decedents (N = 2,510).
  
  
  METHODS
  Medicare costs were calculated for 2, 7, 14, 30, 90, and 180 days before death; Medicaid costs were calculated for dual-eligible beneficiaries. Total costs and costs for hospice, NH, and inpatient care are reported.
  
  
  RESULTS
  Of 2,510 long-stay NH decedents, 35% received hospice. Mean length of hospice was 103 days (median 34 days). Hospice users were more likely to have cancer (P < .001), a do-not-resuscitate order in place (P < .001), greater cognitive impairment (P < .001), and worse activity of daily living (ADL) function (P < .001) and less likely to have had a hospitalization in the year before death (P < .001). In propensity score analyses, hospice users had lower total Medicare costs for all time periods up to and including 90 days before death. For dually eligible beneficiaries, overall costs and Medicare costs were significantly lower for hospice users up to 30 days before death. Medicaid costs were not different between the groups except for the 2-day time period.
  
  
  CONCLUSIONS
  In this analysis of costs to Medicare and Medicaid for long-stay NH decedents, use of hospice did not increase costs in the last 6 months of life. Evidence supporting cost savings is sensitive to analyses that vary the time period before death.
authors.affiliation: Center for Aging Research, Indiana University - Purdue University, Indianapolis, Indiana.|Regenstrief Institute, Inc., Indiana University - Purdue University, Indianapolis, Indiana.|School of Medicine, Indiana University - Purdue University, Indianapolis, Indiana.|RESPECT Signature Center, Indiana University - Purdue University, Indianapolis, Indiana.
authors.forename: Kathleen T
authors.initials: KT
authors.lastname: Unroe
authors.affiliation: Center for Aging Research, Indiana University - Purdue University, Indianapolis, Indiana.|Regenstrief Institute, Inc., Indiana University - Purdue University, Indianapolis, Indiana.|School of Medicine, Indiana University - Purdue University, Indianapolis, Indiana.|RESPECT Signature Center, Indiana University - Purdue University, Indianapolis, Indiana.
authors.forename: Greg A
authors.initials: GA
authors.lastname: Sachs
authors.affiliation: Regenstrief Institute, Inc., Indiana University - Purdue University, Indianapolis, Indiana.
authors.forename: M E
authors.initials: ME
authors.lastname: Dennis
authors.affiliation: School of Nursing, Indiana University - Purdue University, Indianapolis, Indiana.|RESPECT Signature Center, Indiana University - Purdue University, Indianapolis, Indiana.
authors.forename: Susan E
authors.initials: SE
authors.lastname: Hickman
authors.affiliation: School of Medicine, Indiana University - Purdue University, Indianapolis, Indiana.
authors.forename: Timothy E
authors.initials: TE
authors.lastname: Stump
authors.affiliation: Center for Aging Research, Indiana University - Purdue University, Indianapolis, Indiana.|Regenstrief Institute, Inc., Indiana University - Purdue University, Indianapolis, Indiana.
authors.forename: Wanzhu
authors.initials: W
authors.lastname: Tu
authors.affiliation: Center for Aging Research, Indiana University - Purdue University, Indianapolis, Indiana.|Regenstrief Institute, Inc., Indiana University - Purdue University, Indianapolis, Indiana.|School of Medicine, Indiana University - Purdue University, Indianapolis, Indiana.
authors.forename: Christopher M
authors.initials: CM
authors.lastname: Callahan
mesh_terms: D000203:Activities of Daily Living; D000369:Aged, 80 and over; D015897:Comorbidity; D005260:Female; D006738:Hospices / Q000191:economics* / Q000706:statistics & numerical data*; D006801:Humans; D007196:Indiana; D007902:Length of Stay / Q000191:economics* / Q000706:statistics & numerical data; D008297:Male; D008484:Medicaid / Q000191:economics; D006278:Medicare / Q000191:economics; D009369:Neoplasms / Q000453:epidemiology; D009735:Nursing Homes / Q000191:economics*; D057216:Propensity Score; D016414:Resuscitation Orders; D012189:Retrospective Studies; D014481:United States
keywords: costs; hospice; nursing home