Hospital and nursing home use in the last three months of life.

We describe decedents' days of care and changes in residence due to episodes of hospital and institutional care in the last 90 days of life. Data are from the National Institute on Aging's Survey of the Last Days of Life (SLDOL) with informants' responses for a sample of 1,227 decedents age 65 years and older from Fairfield County, Connecticut. Overall, three-fourths of the decedents made only one transition to or from a health care facility in the last 3 months of life and another 10% made two or three transitions. Hospital days decreased slightly with age, but nursing home days increased dramatically. Physical disability, lack of social contacts, incontinence, and a diagnosis of dementia were significantly associated with a long, terminal, institutional stay. Future cost savings are likely to be achieved more through the reduction of nursing home care in the last months of life than in a reduction of hospital care.