Length of Stay for Older Adults Residing in Nursing Homes at the End of Life

Abstract

OBJECTIVES To describe lengths of stay among nursing home decedents. DESIGN Retrospective cohort study. SETTING The Health and Retirement Study (HRS), a nationally representative survey of U.S. adults aged 50 and older. PARTICIPANTS 1,817 nursing home residents who died between 1992 and 2006. MEASUREMENTS Our primary outcome was length of stay, defined as the number of months between the nursing home admission and the date of death. Covariates included demographic, social, and clinical factors drawn from the HRS interview conducted closest to the date of nursing home admission. RESULTS The mean age of decedents was 83.3 (SD 9.0) and the majority were female (59.12%), and White (81.5%). Median and mean length of stay prior to death were 5 months (IQR 1-20) and 13.7 months (SD 18.4), respectively. Fifty-three percent died within 6 months of placement. Large differences in median length of stay were observed by gender (men, 3 months vs. women, 8 months) and net worth (highest quartile, 3 months vs. lowest quartile, 9 months) (all p<.001). These differences persisted after adjustment for age, sex, marital status, net worth, geographic region, and diagnosed chronic conditions (cancer, hypertension, diabetes, lung disease, heart disease, and stroke). CONCLUSION Nursing home lengths of stay are brief for the majority of decedents. Lengths of stay varied markedly by factors related to social support.

Leveraging the Health and Retirement Study To Advance Palliative Care Research

“…Because the HRS tracks subjects through death, including after death interviews with next-ofkin, the HRS can be used to describe subjects who die in nursing homes and the nature of the care they received prior to death. For example, Kelly et al 22 used the HRS to describe the length of stay of HRS subjects who died in the nursing home, finding that the median of 5 months was far less than the mean of 14 months. There is a need, however, to create and test the use of the HRS measures for examining quality of care for nursing home residents with serious illness.…”

Understanding the Impact of Early-Life Trauma in Nursing Home Residents

“…Knowledge of traumatic experiences may emerge over time as trusting relationships are built between residents, family members, and staff. Given that the length of nursing home stays is growing shorter, developing such trusting relationships may be increasingly difficult (Kelly et al, 2010). It is, therefore, important for social workers and admission staff to be up-front with questions about sensitive, past events in the lives of newly admitted residents.…”

New Evidence on the Risk of Requiring Long-Term Care

“…The rest of the long-term care insurance puzzle may be explained by mis-specifications of preferences, omission of other insurance policy features that deter purchase, or behavioral explanations involving myopia or ignorance. 1987-1989Pre 19861977-19781982-19841992-200619851986, 1993, and 2000(projected) 1992-20101982-1989 Table 6. Observed andFitted Health Status Transition Matrices Females 75-84, 1999-2004 Notes: Authors' calculations.…”

“…Recent evidence suggests that those earlier estimates may be extremely misleading in important dimensions. Using Health and Retirement Study (HRS) data from 1992-2010, Hurd, Michaud, and Rohwedder (2013 estimate that men and women aged 50 have a 50 and 65 percent chance, respectively, of ever needing care. But, they also estimate shorter average durations of care, resulting, as we show, from a greater chance of returning to the community, conditional on admission.…”