Quality of Hospice Care at Home Versus in an Assisted Living Facility or Nursing Home

Unroe, Kathleen T.; Stump, Timothy E.; Effler, Shannon; Tu, Wanzhu; Callahan, Christopher M.

doi:10.1111/jgs.15260

Cited by 17 publications

(7 citation statements)

References 22 publications

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“…Some of the employees in the institution are young nurses, and this is their first working experience of palliative care. They are all enthusiastic and having dreams of changing the world, and working here makes them feel proud [17]. In addition, several of the senior employees, who had been helped by others before, were grateful and hoped to give back to society.…”

Section: Discussionmentioning

confidence: 95%

The Experience to Implement Palliative Care in Long-term Care Facilities: A Grounded Theory Study of Caregivers

Chiang

Peng

2021

Asian Nursing Research

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The purpose of this study was to explore the experiences of caregivers in long-term care facilities as they implement palliative care. Although palliative care has been available in Taiwan for more than 30 years, it is often provided in hospitals, few models in the long-term care facilities. Methods: Semi-structured interviews using grounded theory methodology and purposive sampling. Two small long-term care facilities that had performed well in palliative care were selected from eastern Taiwan. A total of 12 caregivers participated in in-depth semi-structured face-to-face interviews. Results: Four major stages in the implementation of palliative care were identified: (1) feeling insecure, (2) clarifying challenges, (3) adapting to and overcoming the challenges, and (4) fully comprehending the meaning of palliative care. The core category of these caregivers as "the guardians at the end of life" reflects the spirit of palliative care. Conclusion: This study demonstrates that successful palliative care implementation would benefit from three conditions. First, the institution requires a manager who is enthusiastic about nursing care and who sincerely promotes a palliative care model. Second, the institution should own caregivers who possess personality traits reflective of enthusiasm for excellence, unusual ambition, and a true sense of mission. Third, early in the implementation phase of the hospice program, the institution must have the consistent support of a high-quality hospice team.

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Section: Discussionmentioning

confidence: 95%

The Experience to Implement Palliative Care in Long-term Care Facilities: A Grounded Theory Study of Caregivers

Chiang

Peng

2021

Asian Nursing Research

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“…Of note, despite evidence that older adults may prefer to avoid nursing home admission close to death, 19 presence in assisted living on the day of death is not a guarantee of high-quality end-of-life care. There is also general agreement about the difficulty of predicting end-of-life disease trajectories among frail older adults, and especially the individuals with dementia, making the management of care transitions to and from assisted living particularly challenging near the end of life.…”

Section: Discussionmentioning

confidence: 99%

Association Between State Regulations Supportive of Third-party Services and Likelihood of Assisted Living Residents in the US Dying in Place

et al. 2022

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ImportanceOlder adults are increasingly residing in assisted living residences during their last year of life. The regulations guiding these residential care settings differ between and within the states in the US, resulting in diverse policies that may support residents who wish to die in place.ObjectiveTo examine the association between state regulations and the likelihood of assisted living residents dying in place. The study hypothesis was that regulations supporting third-party services, such as hospice, increase the likelihood of assisted living residents dying in place.Design, Setting, and ParticipantsThis retrospective cohort study combined data about assisted living residences in the US from state registries with an inventory of state regulations and administrative claims data. The study participants comprised 168 526 decedents who were Medicare beneficiaries, resided in 8315 large, assisted living residences (with ≥25 beds) across 301 hospital referral regions during the last 12 months of their lives, and died between 2017 and 2019. Descriptive analyses were performed at the state level, and 3-level multilevel models were estimated to examine the association between supportive third-party regulations and dying in place in assisted living residences. The data were analyzed from September 2021 to August 2022.ExposuresSupportive (vs “silent,” ie, not explicitly mentioned in regulatory texts) state regulations regarding hospice care, private care aides, and home health services, as applicable to licensed/registered assisted living residences across the US.Main Outcomes and MeasuresPresence in assisted living residences on the date of death.ResultsThe median (IQR) age of the 168 526 decedents included in the study was 90 (84-94) years. Of these, 110 143 (65.4%) were female and 158 491 (94.0%) were non-Hispanic White. Substantial variation in the percentage of assisted living residents dying in place was evident across states, from 18.0% (New York) to 73.7% (Utah). Supportive hospice and home health regulations were associated with a higher odds of residents dying in place (adjusted odds ratio [AOR], 1.38; 95% CI, 1.24-1.54; P &lt; .001; and AOR, 1.21; 95% CI, 1.10-1.34; P &lt; .001, respectively). In addition, hospice regulations remained significant in fully adjusted models (AOR, 1.46; 95% CI, 1.25-1.71).Conclusions and RelevanceThe findings of this cohort study suggest that a higher percentage of assisted living residents died in place in US states with regulations supportive of third-party services. In addition, assisted living residents in licensed settings with regulations supportive of hospice regulations were especially likely to die in place.

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“…In addition, a contributing factor that we were unable to study in our analysis was the setting (e.g., home, hospital, hospice inpatient) in which patients received hospice care. Prior studies have reported better quality of hospice care when it is delivered at home vs in nursing homes (NH) and assisted living facilities (ALF) 16,17 and a greater proportion of dementia patients on hospice receive care in an NH and ALF when compared with other terminal diagnoses. 17 This calls for further research looking into the care that is received in different hospice settings and how that may impact the differences we see in care for dementia patients at the end-of-life.…”

Section: Discussionmentioning

confidence: 99%

Hospice Composition Based on Diagnosis is Associated with Caregiver-Reported Quality Measures

Alshakhs

Sweet

Luth

et al. 2022

Am J Hosp Palliat Care

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Context: Given that the composition of hospice patients’ terminal diagnoses has become increasingly diverse, understanding whether hospices provide quality care to patients, regardless of disease, is important. However, data comparing diagnosis and caregiver-reported outcomes remain scarce. Objectives: To analyze the association between the composition of patients’ terminal diagnoses and caregiver-reported quality measures. Methods: Using cross-sectional, publicly available data from the Centers for Medicare & Medicare Services (CMS), we analyzed data collected from 2015–2019. We conducted general linear model analyses to identify associations between hospice characteristics/practices and caregiver-reported outcomes. Results: Of the 2810 hospices, those that cared for a greater percentage of dementia patients had fewer caregivers, on average, who rated hospice a 9 or 10 (where 0 = low, 10 = high; β = −.094; 95% CI = −.147, −.038), reported they always received help for pain and symptoms (β = −.106, CI = −.156, −.056), and reported definitely having received the training they needed (β = −.151, CI = −.207, −.095). Those caring for more stroke patients had fewer caregivers, on average, who rated hospice a 9 or 10 (β = −.184, CI = .252, −.115), reported they always received help for pain and symptoms (β = −.188, CI = −.251, −.126), reported definitely having received the training they needed (β = −.254, CI = −.324, −.184), and reported that the hospice offered the right amount of emotional/spiritual support (β = −.056, CI = −.093, −.019). Conclusion: Hospices that cared for a greater proportion of dementia and stroke patients had poorer scores on caregiver-reported quality measures. These findings support efforts to identify mechanisms underlying these differences and to design strategies to ensure optimal outcomes for hospice patients regardless of diagnosis.

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Quality of Hospice Care at Home Versus in an Assisted Living Facility or Nursing Home

Cited by 17 publications

References 22 publications

The Experience to Implement Palliative Care in Long-term Care Facilities: A Grounded Theory Study of Caregivers

The Experience to Implement Palliative Care in Long-term Care Facilities: A Grounded Theory Study of Caregivers

Association Between State Regulations Supportive of Third-party Services and Likelihood of Assisted Living Residents in the US Dying in Place

Hospice Composition Based on Diagnosis is Associated with Caregiver-Reported Quality Measures

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