Differential utilization of hospice services in nursing homes.

During the completion of an interpretive evaluation project, differences in rates of dying patients using hospice services between nursing homes were examined. Rates were found to vary from 2% to 39% in 23 nursing homes owned by one company. Twenty of the 23 administrators responded to a survey regarding attitudes toward hospice care in the nursing home. Nursing homes with administrators most sympathetic to hospice care had rates three times higher than nursing homes with administrators least sympathetic. Specific concerns were discussed in interviews with four of the least sympathetic administrators. The findings are congruent with program implementation theory which describes the discretionary power of local administrators to limit access to new programs that they find problematic.