We know little about end-of-life care in nursing homes (NHs) or the hospice influence on this care. This research tested the effect of Medicare hospice enrollment on end of life pain management in NHs. Studied were NH hospice decedents in Kansas, Maine, Mississippi, New York and South Dakota who had at least 2 assessments (MDSs) completed between 1992 and 1996, 1 of which was after hospice admission (2,644). For each hospice decedent, 3 non-hospice decedents (2 in 2 cases) were chosen by matching on state, 1 of 3 diagnosis groups, and the time from last MDS to death (n=7929). Hospice enrollees had greater ADL and cognitive impairment, a lower body mass index, and more daily pain documented (30% versus 18%) than did non-enrollees. 57% of hospice enrollees and 39% of non-hospice enrollees in daily pain received regular treatment (any analgesic twice a day for five days) for their pain. Multiple logistic regression that controlled for patient case-mix, state of NH residence, and, through GEE, the non-independence of residents in the same NH, showed hospice enrollment to be significantly associated with a 93% (95% CI 1.56, 2.38) increased likelihood of receiving regular treatment for daily pain. These findings support the premise that hospice care in NHs is a viable means for improving pain management for dying NH residents. However, additional research is needed to gain a better understanding of why higher percentages of hospice and non-hospice NH decedents were not observed as having had regular treatment for their daily pain.
Learning Objectives: At the conclusion of the session the attendees will be able to: 1. Discuss how nursing home residents who elect hospice differ from those not electing hospice. 2. Describe how pain management differs for dying nursing home residents electing and not electing Medicare hospice care
Keywords: End-of-Life Care, Nursing Homes
Presenting author's disclosure statement:
Organization/institution whose products or services will be discussed: None
I have a significant financial interest/arrangement or affiliation with any organization/institution whose products or services are being discussed in this session.
Relationship: Division of Disability, Aging and Long-Term Care
Office of the Assistant Secretary for Planning and Evaluation
U.S. Department of Health and Human Services