title: Variation in Hospice Services by Location of Care: Nursing Home Versus Assisted Living Facility Versus Home.
abstract: OBJECTIVE
  To describe differences in hospice services for patients living at home, in nursing homes or in assisted living facilities, including the overall number and duration of visits by different hospice care providers across varying lengths of stay.
  
  
  METHODS
  Retrospective cohort study using hospice patient electronic medical record data.
  
  
  METHODS
  Large, national hospice provider.
  
  
  METHODS
  Data from 32,605 hospice patients who received routine hospice care from 2009 to 2014 were analyzed.
  
  
  METHODS
  Descriptive statistics were calculated for utilization measures for each type of provider and by location of care. Frequency and duration of service contacts were standardized to a 1 week period and pairwise comparisons were used to detect differences in care provided between the three settings.
  
  
  RESULTS
  Minimal differences were found in overall intensity of service contacts across settings, however, the mix of services were different for patients living at home versus nursing home versus assisted living facility. Overall, more nurse care was provided at the beginning and end of the hospice episode; intensity of aide care services was higher in the middle portion of the hospice episode. Nearly 43% of the sample had hospice stays less than 2 weeks and up to 20% had stays greater than 6 months.
  
  
  CONCLUSIONS
  There are significant differences between characteristics of hospice patients in different settings, as well as the mix of services they receive. Medicare hospice payment methodology was revised starting in 2016. While the new payment structure is in greater alignment with the U shape distribution of services, it will be important to evaluate the impact of the new payment methodology on length of stay and mix of services by different providers across settings of care.
authors.affiliation: Indiana University Center for Aging Research, Indianapolis, Indiana.|Regenstrief Institute, Inc., Indianapolis, Indiana.|Department of Medicine, Indiana University School of Medicine, Indianapolis, Indiana.
authors.forename: Kathleen T
authors.initials: KT
authors.lastname: Unroe
authors.affiliation: Indiana University Center for Aging Research, Indianapolis, Indiana.|Regenstrief Institute, Inc., Indianapolis, Indiana.
authors.forename: Brittany
authors.initials: B
authors.lastname: Bernard
authors.affiliation: Department of Biostatistics, Indiana University School of Medicine, Indianapolis, Indiana.
authors.forename: Timothy E
authors.initials: TE
authors.lastname: Stump
authors.affiliation: Indiana University Center for Aging Research, Indianapolis, Indiana.|Regenstrief Institute, Inc., Indianapolis, Indiana.|Department of Medicine, Indiana University School of Medicine, Indianapolis, Indiana.|Department of Biostatistics, Indiana University School of Medicine, Indianapolis, Indiana.
authors.forename: Wanzhu
authors.initials: W
authors.lastname: Tu
authors.affiliation: Indiana University Center for Aging Research, Indianapolis, Indiana.|Regenstrief Institute, Inc., Indianapolis, Indiana.|Department of Medicine, Indiana University School of Medicine, Indianapolis, Indiana.
authors.forename: Christopher M
authors.initials: CM
authors.lastname: Callahan
mesh_terms: D040561:Assisted Living Facilities / Q000706:statistics & numerical data*; D057286:Electronic Health Records; D005102:Health Expenditures; D006699:Home Care Services / Q000706:statistics & numerical data*; D017051:Hospice Care / Q000706:statistics & numerical data*; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data; D006278:Medicare / Q000191:economics; D009735:Nursing Homes / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D014481:United States
keywords: financing health care; health reform; hospice; long-term care