Meredith Dougherty1, Pamela S Harris2, Joan Teno3, Amy M Corcoran4, Cindy Douglas5, Jackie Nelson6, Deborah Way7, Joan E Harrold8, David J Casarett1. 1. Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania. 2. Kansas City Hospice and Palliative Care, Kansas City, Missouri. 3. Warren Alpert School of Medicine, Brown University, Providence, Rhode Island. 4. Milton S. Hershey Medical Center, College of Medicine, Penn State University, Hershey, Pennsylvania. 5. Faith Presbyterian Hospice, Dallas, Texas. 6. Arbor Hospice, Ann Arbor, Michigan. 7. Philadelphia Veterans Affairs Medical Center, Philadelphia, Pennsylvania. 8. Hospice and Community Care, Lancaster, Pennsylvania.
Abstract
OBJECTIVES: To compare residents of assisted living facilities receiving hospice with people receiving hospice care at home. DESIGN: Electronic health record-based retrospective cohort study. SETTING: Nonprofit hospices in the Coalition of Hospices Organized to Investigate Comparative Effectiveness network. PARTICIPANTS: Individuals admitted to hospice between January 1, 2008, and May 15, 2012 (N = 85,581; 7,451 (8.7%) assisted living facility, 78,130 (91.3%) home). MEASUREMENTS: Hospice length of stay, use of opioids for pain, and site of death. RESULTS: The assisted living population was more likely than the home hospice population to have a diagnosis of dementia (23.5% vs 4.7%; odds ratio (OR) = 13.3, 95% confidence interval (CI) = 12.3-14.4; P < .001) and enroll in hospice closer to death (median length of stay 24 vs 29 days). Assisted living residents were less likely to receive opioids for pain (18.1% vs 39.7%; OR = 0.33, 95% CI = 0.29-0.39, P < .001) and less likely to die in an inpatient hospice unit (9.3% vs 16.1%; OR = 0.53, 95% CI = 0.49-0.58, P < .001) or a hospital (1.3% vs 7.6%; OR = 0.16, 95% CI = 0.13-0.19, P < .001). CONCLUSION: Three are several differences between residents of assisted living receiving hospice care and individuals living at home receiving hospice care. A better understanding of these differences could allow hospices to develop guidelines for better coordination of end-of-life care for the assisted living population.
OBJECTIVES: To compare residents of assisted living facilities receiving hospice with people receiving hospice care at home. DESIGN: Electronic health record-based retrospective cohort study. SETTING: Nonprofit hospices in the Coalition of Hospices Organized to Investigate Comparative Effectiveness network. PARTICIPANTS: Individuals admitted to hospice between January 1, 2008, and May 15, 2012 (N = 85,581; 7,451 (8.7%) assisted living facility, 78,130 (91.3%) home). MEASUREMENTS: Hospice length of stay, use of opioids for pain, and site of death. RESULTS: The assisted living population was more likely than the home hospice population to have a diagnosis of dementia (23.5% vs 4.7%; odds ratio (OR) = 13.3, 95% confidence interval (CI) = 12.3-14.4; P < .001) and enroll in hospice closer to death (median length of stay 24 vs 29 days). Assisted living residents were less likely to receive opioids for pain (18.1% vs 39.7%; OR = 0.33, 95% CI = 0.29-0.39, P < .001) and less likely to die in an inpatient hospice unit (9.3% vs 16.1%; OR = 0.53, 95% CI = 0.49-0.58, P < .001) or a hospital (1.3% vs 7.6%; OR = 0.16, 95% CI = 0.13-0.19, P < .001). CONCLUSION: Three are several differences between residents of assisted living receiving hospice care and individuals living at home receiving hospice care. A better understanding of these differences could allow hospices to develop guidelines for better coordination of end-of-life care for the assisted living population.
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