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The average number of daily hospice visits to dying patients is similar, whether the patients are in nursing homes (NHs) or other settings. However, the mix of services varies, according to a recent study supported in part by the Agency for Healthcare Research and Quality (HS11004). For example, compared with non-NH patients, NH patients had a 41 percent lower probability of having a nurse average daily visit volume above the median, but they were two to three times as likely to have social worker, aide, and clergy average daily visits above the median.
This different mix of services—but not overall volume of hospice services—appears to be used to address the differing patient/family physical, psychosocial, and spiritual needs in these two settings. Based on these findings, differential Medicare hospice payments in NH and non-NH sites of care do not appear to be warranted, concludes Susan C. Miller, Ph.D., of the Brown University School of Medicine. She retrospectively studied data from 21 hospices owned by the same provider across seven States. The data used to examine the association between site of care and probability of daily hospice visits covered 9,460 NH hospice patients and 15,484 non-NH hospice patients.
Overall, the average daily visit volume was 1.2; the mean was 1.1 (standard deviation [SD] 1.3) in NHs and 1.2 (SD 1.1) in non-NH settings. Considering all patients, the medians of average daily visit volumes were 0.8 for all visits, 0.4 for nursing, 0.2 for aide, 0.03 for social worker, 0.02 for clergy, and 0 for physician visits. Being cared for in a NH was associated with a slightly greater (although not statistically significant) likelihood of having an average daily visit volume above the sample's median. In both settings, the likelihood of having average daily visits above the median increased dramatically when hospice lengths of stay were short. For example, compared with hospice stays between 31 and 180 days, having a hospice stay of 1-7 days in either care setting was associated with an over 20 times greater likelihood of receiving average daily visits above the sample median.
See "Hospice care in nursing homes: Is site of care associated with visit volume?" by Dr. Miller, in the August 2004 Journal of the American Geriatrics Society 52, pp. 1331-1336.
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