Black and White Differences in Hospice Use among U.S. Nursing Home Decedents

Abstract

Objectives 1. Describe how rates of hospice use increased between 1999 and 2006 and which United States has the greatest proportions of nursing home decedent who enroll in hospice. 2. Discuss how the change in the volume of Medicare certified hospice providers within states is associated with change in hospice use in nursing homes. I. Background. A high proportion of nursing homes (NHs) contract with hospice providers (78% in 2004) to assist them in providing palliative care to dying NH residents. However, while the Medicare Payment Advisory Commission has documented much growth in hospice use, changes in hospice use in United States. NHs have not been documented. II. Research Objectives. This study aimed to document the use of hospice care in the United States NHs within the 48 contiguous states in years 1999 through 2006 and to describe the growth of Medicare certified hospice providers in relation to this growth. III. Methods. This longitudinal study merged resident assessment data (MDS) with Medicare denominator and Part A claims data to identify Medicare NH decedents and hospice use. Descriptive statistics highlight changes in use. IV. Results. Between 1999 and 2006 the use of hospice care in U.S. NHs more than doubled. In 1999, 14.0% of NH decedents accessed hospice while 33.2% accessed hospice in 2006 (a 137% increase). Still, the rate of NH hospice use varied dramatically across states, with in 2006 a high of 56.6% in Oklahoma and a low of 8.1% in Vermont. In 26 states there are strong statistically significant positive correlations between the yearly increases in the number of hospice providers and the rates of hospice use. States with these significant correlations had a 182% increase in NH hospice use between 1999 and 2006 while use increased by 126% in other states. V. Conclusion. The use of hospice care in U.S. NHs has increased substantially and this growth appears to be associated in part with the growth in Medicare certified hospice providers. VI. Implications for Research, Policy, or Practice. Planned longitudinal analyses controlling for NH, county and state-level variables will inform policy by providing a more definitive understanding of changes in NH hospice use and the factors influencing observed changes.