The 131st Annual Meeting (November 15-19, 2003) of APHA

Abstract #67369

Susan C. Miller, PhD¹, Orna Intrator, PhD², Pedro Gozalo, PhD¹, Jason Roy, PhD¹, and Vincent Mor, PhD¹. (1) Center for Gerontology and Health Care Research and Department of Community Health, Brown University, 2 Stimson Street, Room 207, Providence, RI 02912, (401) 863-9216, Susan_Miller@brown.edu, (2) Center for Gerontology and Health Care Research, Brown Medical School, Box G-H3, Providence, RI 02912

Specific Purpose: This study’s purpose was to examine whether hospice enrollment was associated with end of life expenditures for short and longer-stay nursing home decedents.

Content: We studied 2,850 dually eligible nursing home residents who died in Florida nursing homes in 1999 and had diagnoses other than cancer or Alzheimer’s disease or dementia.

Methodology: We used Medicaid and Medicare claims data to determine hospice enrollment and government expenditures in the last month of life. Resident case-mix data were obtained from the resident assessment (MDS). Analyses were stratified by whether nursing home stay was short (<=90 days; N=698)) or longer (N=2,080). Linear regression models were used to test the hospice effect. Dummy variables represented whether residents were enrolled in hospice for the entire last month of life, versus some portion of that month.

Results: Twenty percent of short-stay and 24% of longer stay residents enrolled in hospice. Of these, 19% of short-stay and 43% of longer-stay residents received hospice for the entire last month of life. For short-stay residents, hospice was significantly associated with lower expenditures; there was a greater hospice effect when enrollment was for the entire month. For longer-stay residents, expenditures for hospice and nonhospice residents were not significantly different.

Importance: Findings suggest hospice care in nursing homes does not significantly increase government expenditures for residents with noncancer and nondementia diagnoses. For short-stay nursing home residents, hospice significantly decreases expenditures.

Learning Objectives:

At the conclusion of the session, the participant (learner) in this session will be able to:
• Describe how Medicare and Medicaid expenditures differ by hospice enrollment for nursing home residents with noncancer and nondementia diagnoses.
• Articulate other factors significantly associated with government expenditures.
• Discuss what these findings may mean in terms of use of hospice care in nursing homes.

Presenting author's disclosure statement:
I do not have any significant financial interest/arrangement or affiliation with any organization/institution whose products or services are being discussed in this session.