Factors Associated with Community Residence at the End of Life: A Population-Based Study (TH321B)

Abstract

•State the prevalence of decedents by residential setting (community, community with supportive services, and nursing home) at the end of life in a national sample of Medicare beneficiaries.•Compare the clinical characteristics of decedents across residential setting (community, community with supportive services, and nursing home) at the end of life.•Explain how socioeconomic factors of decedents are associated with end of life residential setting (community, community with supportive services, and nursing home). Residence in the community in the last phase of life has increased substantially in the last two decades and encompasses a range of different types of residential care environments. Determine the associations between demographic, clinical, and socioeconomic characteristics and residential setting at the end of life. We used the Medicare Current Beneficiary Survey (2011-2013) linked to administrative data. We characterized residential setting as community, community plus supportive services (e.g., personal care, medication assistance, meal preparation, transportation), or nursing home. We used multinomial logistic regression to identify characteristics associated with residential setting at the end of life. Of 1,385 decedents, 53.8% resided in the community, 7.7% in the community with supportive services, and 38.5% in nursing homes. Those in the community with supportive services and those in nursing homes had similar clinical characteristics including high rates of dementia (36.4% and 43.2%) and ADL impairment (2.3 and 3.1) but different socioeconomic characteristics. Those in the community without supportive services had higher rates of cancer and were more likely to be younger, married, and non-white than those in other settings. Higher education was independently associated with residing in the community with supportive services versus nursing homes (OR=2.1, 95% CI 1.1, 4.2) and versus residing in the community without supportive services (OR=3.4, 95% CI 1.7, 6.8). Socioeconomic factors are associated with whether individuals remain in the community with supportive services or reside in nursing homes at the end of life independent of clinical and functional characteristics. A combination of clinical, functional, and socioeconomic factors are associated with residing in the community without supportive services at the end of life.