Institutional Special Needs Plans and Hospice Enrollment in Nursing Homes: A National Analysis

Abstract

BACKGROUND Institutional Special Needs Plans (I‐SNPs) in nursing homes could impact hospice use by residents with advanced illness. Little is known about their relationship. OBJECTIVE To determine whether I‐SNP availability has been associated with changes in hospice utilization. DESIGN Federal data from 2011 and 2013 were extracted from the Minimum Data Set (MDS) and other sources. Multilevel models evaluated I‐SNP–, resident‐, and facility‐related variables as predictors of hospice utilization. SETTING All US nursing homes in 2011 (N = 15 750) and 2013 (N = 15 732). PARTICIPANTS Nursing home residents enrolled in Medicare or in both Medicare and Medicaid. MEASUREMENTS Nursing home and resident data were obtained from Centers for Medicare and Medicaid Services sources: the MDS 3.0, Master Summary Beneficiary File, and Special Needs Plan Comprehensive Report. RESULTS The mean number of residents per nursing home was 210.9 (SD = 167.1) in 2011 and 217.2 (SD = 171.5) in 2013. The prevalence of I‐SNP contracts in nursing homes increased between 2011 and 2013, from 55.2% (N = 8691) to 61.1% (N = 9605), respectively (P < .001). In multivariate analyses, greater hospice enrollment in nursing homes was associated with having at least one I‐SNP enrollee per month; year (2013 higher than 2011); smaller facility size; urban (vs rural) setting; location in the Northeast (vs Midwest); lower average resident mental status; higher average resident mobility; younger residents, on average; and facilities with higher proportions of residents with specific diagnoses (cancer, cirrhosis, and dementia). After adjusting for resident and nursing home characteristics, the association between monthly I‐SNP presence and hospice enrollment was found only in nursing homes with 50 or greater beds and there was a positive relationship with increasing size. CONCLUSIONS Growth of I‐SNPs has been associated with changes in hospice utilization, and the relationship varies by facility size. Studies are needed to clarify the nature of this association and determine whether care may be improved through coordination of these programs. J Am Geriatr Soc 67:2537–2544, 2019

Nursing Home Staff Perceptions of End-of-Life Care for Residents With Advanced Dementia

“…Hospice in the United States is a Medicare-funded insurance benefit designed to provide end-of-life care to Americans with a life expectancy of 6 months or less. Most NHs (93.3%) have an active hospice contract to augment the care provided to residents at the end of life 7 . Hospice has been shown to improve the care of dying NH residents including reducing the risk of end-of-life hospitalizations 8 .…”

“…Most NHs (93.3%) have an active hospice contract to augment the care provided to residents at the end of life. 7 Hospice has been shown to improve the care of dying NH residents including reducing the risk of end-of-life hospitalizations. 8 However, hospice utilization is low among NH residents.…”