224127 Nursing Home Residents with End-Stage Dementia and Medicare SNF Care: How Is Hospice Enrollment Associated with Site of Death?

Monday, November 8, 2010 : 3:30 PM - 3:42 PM

Susan C. Miller, PhD , Center for Gerontology and Health Care Research, The Warren Alpert Medical School of Brown University, Providence, RI
Julie Lima, PhD , Center for Gerontology and Health Care Research, The Warren Alpert Medical School of Brown University, Providence, RI
Susan L. Mitchell, MD MPH , Hebrew SeniorLife Institute for Aging Research and Department of Medicine of Beth Israel Deaconess Medical Center, Roslindale, MA
Objective: To identify how hospice enrollment is associated with site of death for nursing home (NH) residents with end-stage dementia who receive Medicare skilled nursing facility (SNF) care near the end of life.

Methods: In the 50 U.S. states and the District of Columbia we merged resident assessment data (MDS) with Medicare claims and denominator data to identify hospice enrollment and hospital use for year 2006 NH decedents having end-stage dementia and receiving Medicare SNF care in the last 90 days of life (N= 19,271). We conducted multivariate logistic regression with a generalized estimating equation and clustered on NHs (N=8,454) to examine the association between hospice enrollment and a hospital death, controlling for individual and NH-level variables.

Results: Thirty-three percent of residents with end-stage dementia and SNF care enrolled in hospice. One percent of decedents with hospice had a hospital death, compared to 17% of nonhospice decedents. Hospice enrollment was associated with a 94% lower likelihood of dying in a hospital (AOR 0.06; 95% CI 0.046, 0.076). Controlling for hospice enrollment, residents with a recognized six-month prognosis (per the MDS) and with do not resuscitate and/or do not hospitalize orders had a significantly lower likelihood of a hospital death. Nonwhite and Hispanic residents had a significantly greater likelihood of a hospital death as did those residents in for-profit NHs.

Implications: End-stage dementia residents who enroll in hospice have a greater likelihood of dying in place and this lower hospital use at the end-of-life may result in dollar savings for Medicare.

Learning Areas:
Advocacy for health and health education
Chronic disease management and prevention
Conduct evaluation related to programs, research, and other areas of practice
Public health or related public policy

Learning Objectives:
At the conclusion of the session, the participant (learner) in this session will be able to: 1. Describe characteristics of end-stage dementia residents who receive Medicare SNF care in the last 90 days of life and how these characteristics differ by hospice enrollment. 2. Describe how hospice enrollment is associated with a hospital death. 3. Discuss other factors associated with a greater and lesser likelihood of a hospital death.

Keywords: Dementia, End-of-Life Care

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I have been conducting research on end-of-life care in nursing homes for over ten years.
Any relevant financial relationships? Yes

Name of Organization Clinical/Research Area Type of relationship
National Hospice Foundation Medicare Payment Grant funding

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.