Variation in Hospice Services by Location of Care

Nursing Home Versus Assisted Living Facility Versus Home

Kathleen Unroe, Brittany Bernard, Timothy E. Stump, Wanzhu Tu, Christopher Callahan

Research output: Contribution to journalArticle

2 Citations (Scopus)

Abstract

Objectives: 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. Design: Retrospective cohort study using hospice patient electronic medical record data. Setting: Large, national hospice provider. Participants: Data from 32,605 hospice patients who received routine hospice care from 2009 to 2014 were analyzed. Measurements: 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. Conclusion: 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.

Original languageEnglish (US)
JournalJournal of the American Geriatrics Society
DOIs
StateAccepted/In press - 2017

Fingerprint

Assisted Living Facilities
Hospices
Nursing Homes
Home Nursing
Hospice Care
Length of Stay
Electronic Health Records
Medicare
Cohort Studies
Retrospective Studies
Nurses

Keywords

  • Financing health care
  • Health reform
  • Hospice
  • Long-term care

ASJC Scopus subject areas

  • Geriatrics and Gerontology

Cite this

@article{9a59d9c01cca4eefa74fc21ecf970a2b,
title = "Variation in Hospice Services by Location of Care: Nursing Home Versus Assisted Living Facility Versus Home",
abstract = "Objectives: 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. Design: Retrospective cohort study using hospice patient electronic medical record data. Setting: Large, national hospice provider. Participants: Data from 32,605 hospice patients who received routine hospice care from 2009 to 2014 were analyzed. Measurements: 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. Conclusion: 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.",
keywords = "Financing health care, Health reform, Hospice, Long-term care",
author = "Kathleen Unroe and Brittany Bernard and Stump, {Timothy E.} and Wanzhu Tu and Christopher Callahan",
year = "2017",
doi = "10.1111/jgs.14826",
language = "English (US)",
journal = "Journal of the American Geriatrics Society",
issn = "0002-8614",
publisher = "Wiley-Blackwell",

}

TY - JOUR

T1 - Variation in Hospice Services by Location of Care

T2 - Nursing Home Versus Assisted Living Facility Versus Home

AU - Unroe, Kathleen

AU - Bernard, Brittany

AU - Stump, Timothy E.

AU - Tu, Wanzhu

AU - Callahan, Christopher

PY - 2017

Y1 - 2017

N2 - Objectives: 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. Design: Retrospective cohort study using hospice patient electronic medical record data. Setting: Large, national hospice provider. Participants: Data from 32,605 hospice patients who received routine hospice care from 2009 to 2014 were analyzed. Measurements: 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. Conclusion: 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.

AB - Objectives: 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. Design: Retrospective cohort study using hospice patient electronic medical record data. Setting: Large, national hospice provider. Participants: Data from 32,605 hospice patients who received routine hospice care from 2009 to 2014 were analyzed. Measurements: 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. Conclusion: 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.

KW - Financing health care

KW - Health reform

KW - Hospice

KW - Long-term care

UR - http://www.scopus.com/inward/record.url?scp=85015225657&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85015225657&partnerID=8YFLogxK

U2 - 10.1111/jgs.14826

DO - 10.1111/jgs.14826

M3 - Article

JO - Journal of the American Geriatrics Society

JF - Journal of the American Geriatrics Society

SN - 0002-8614

ER -