A growing number of nursing homes are collaborating with Medicare-certified hospice providers to provide palliative care to their dying residents, and resident referrals to Medicare hospices have increased. In fact, a new study finds that delivery of hospice care in nursing homes has increased significantly over time. However, current efforts aimed at reducing Medicare hospice costs may have a negative impact on the availability of hospice care in nursing homes, caution the Brown University researchers. They analyzed resident assessment data merged with Medicare Part A claims data on nursing home residents who died in 1999 through 2006 in all 50 States and the District of Columbia. Medicare Part A claims included not only hospice care, but also hospital, home health, outpatient, and skilled nursing facility care.
From this information, the researchers determined which residents died while in the nursing home (or within 7 days of transfer to a hospital), the proportion of these residents who received hospice, and their total days of Medicare hospice care. In 1999, the number of Medicare hospice beneficiaries in nursing homes was 101,843. By 2006, this number had doubled to 233,844 beneficiaries. This growth resulted in part from the growth in the number of hospices providing care in nursing homes, which jumped from 1,850 in 1999 to 2,768 in 2006, a growth rate of 49.6 percent. Rates of nursing home hospice use more than doubled from 14 percent in 1999 to 33 percent in 2006. Mean lengths of stay also increased, from just 46 days in 1999 to 93 days by 2006. In 1999, 69 percent of patients in nursing home hospice died from a noncancer diagnosis. This increased to 83 percent in 2006.
Most hospice patients in nursing homes were female, white, and aged 85 and older. Alaska, Hawaii, Wyoming, and Vermont had the lowest rates of nursing home hospice use. Several States in the South and Southwest had the most provider growth for nursing home hospice care. The study was supported in part by the Agency for Healthcare Research and Quality (HS16918).
See "The growth of hospice care in U.S. nursing homes," by Susan C. Miller, Ph.D., Julie Lima, Ph.D., Pedro L. Gozalo, Ph.D., and Vincent Mor, Ph.D., in the Journal of the American Geriatrics Society 58, pp. 1481-1488, 2010.