Dataset Information

State Regulations and Hospice Utilization in Assisted Living During the Last Month of Life.

ABSTRACT:

Objectives

To examine the association between hospice/staffing regulations in residential care or assisted living (RC/AL) and hospice utilization among a national cohort of Medicare decedents residing in RC/AL at least 1 day during the last month of life, and to describe patterns of hospice utilization.

Design

Retrospective cohort study of fee-for-service Medicare beneficiaries who died in 2018 and resided in an RC/AL community with ≥25 beds at least 1 day during the last month of life.

Setting/participants

23,285 decedents who spent time in 6274 RC/AL communities with 146 state license classifications.

Methods

Descriptive statistics about hospice use; logistic regression models to test the association between regulations supportive of hospice care or registered nurse (RN) staffing requirements and the odds of hospice use in RC/AL in the last month of life.

Results

More than half (56.4%) of the study cohort received hospice care in RC/AL at some point during the last 30 days of life, including 5.7% who received more intensive continuous home care (CHC). A larger proportion of decedents who resided in RC/ALs with supportive hospice policies received hospice (57.3% vs 52.6%), with this difference driven by more CHC hospice programs. This association remained significant after controlling for sociodemographic characteristics, comorbidities, time spent in RC/AL, and Hospital Referral Region fixed effects. Decedents in RC/ALs with explicit RN staffing requirements had significantly less CHC use (2.0% vs 6.8%).

Conclusions and implications

A large proportion of RC/AL decedents received hospice care in RC/AL regardless of differing regulations. Those in licensed settings with explicitly supportive hospice regulations were significantly more likely to receive hospice care in RC/AL during the last month of life, especially CHC level of hospice care. Regulatory change in states that do not yet explicitly allow hospice care in RC/AL may potentially increase hospice utilization in this setting, although the implications for quality of care remain unclear.

SUBMITTER: Belanger E

PROVIDER: S-EPMC9237186 | biostudies-literature | 2022 Aug

REPOSITORIES: biostudies-literature

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Publications

State Regulations and Hospice Utilization in Assisted Living During the Last Month of Life.

Belanger Emmanuelle E Teno Joan M JM Wang Xiao Joyce XJ Rosendaal Nicole N Gozalo Pedro L PL Dosa David D Thomas Kali S KS

Journal of the American Medical Directors Association 20211228 8

<h4>Objectives</h4>To examine the association between hospice/staffing regulations in residential care or assisted living (RC/AL) and hospice utilization among a national cohort of Medicare decedents residing in RC/AL at least 1 day during the last month of life, and to describe patterns of hospice utilization.<h4>Design</h4>Retrospective cohort study of fee-for-service Medicare beneficiaries who died in 2018 and resided in an RC/AL community with ≥25 beds at least 1 day during the last month of ...[more]

PMID: 34971591

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Dataset Information

State Regulations and Hospice Utilization in Assisted Living During the Last Month of Life.

Objectives

Design

Setting/participants

Methods

Results

Conclusions and implications

Publications

State Regulations and Hospice Utilization in Assisted Living During the Last Month of Life.

Similar Datasets

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