Racial disparities in end-of-life planning and services for deceased nursing home residents.

OBJECTIVE: This study examined the relationship between race and advance directives, hospice services, and hospitalization at the end of life among deceased nursing home residents.
DESIGN: Secondary data analysis using the 2007 Minimum Data Set (MDS) was used to identify nursing home residents who died during the year, as well as to explore relationships between race and the study variables of interest.
SETTING: US nursing homes certified for Medicare or Medicaid reimbursement were included in the study. PARTICIPANTS: Nursing home residents 65 years of age and older who had a completed MDS full assessment and one quarterly assessment, and died while residing in the facility during 2007. MEASUREMENTS: MDS documentation of advance directive measures, hospice use, and hospitalizations were assessed for white, black, Hispanic, and Asian residents with linear regression models fitted to each dependent variable (outcome) with "race" as the main predictor.
RESULTS: Across different types of advance directives, black, Hispanic, and Asian nursing home residents were significantly less likely to have these documented in their files. Compared with white residents, Asian residents were also significantly less likely to receive hospice services during their last year of life, whereas Hispanic residents were more likely to receive services. Finally, all racial groups were more likely to experience hospitalization within 90 days before death, regardless of whether they had documentation of a do not hospitalize order.
CONCLUSION: As the racial profile of nursing home residents becomes more diverse, recognizing differences in end-of-life planning and treatment preferences, as well as the implementation of tailored programs for specific groups, will continue to increase in importance.