Symptom Burden and Activity of Daily Living (ADL) Dependency Among Home Health care Patients Discharged to Home Hospice

Abstract

Background: We sought to examine sociodemographic and clinical characteristics present on admission to HHC associated with discharge to hospice. Methods: We used a 5% random sample of 2017 national Outcome and Assessment Information Set (OASIS) data. A Cox proportional hazards regression model was estimated for the primary outcome (discharge to hospice) to examine the associations with sociodemographic and clinical characteristics of HHC patients. Results: Among 489, 230 HHC patients, 4268 were discharged to hospice. The median (interquartile range) length of HHC stay for patients discharged to hospice care was 33 (14-78) days. Compared to White patients, Black, Hispanic, and other race, (hazard ratio [HR] = .50 [95% confidence interval, CI = .44–.57]), (HR = .53 [95% CI = .46–.62]), and (HR = .49 [95% CI = .40–.61], respectively) was associated with shorter time to discharge to hospice care. Clinical characteristics including severe dependence in activities of daily (ADL) (HR = 1.68 [95% CI = 1.01–2.78]), cognitive impairment (HR = 1.10 [95% CI = 1.01–1.20]), disruptive behavior daily (HR = 1.11 [95% CI = 1.02–1.22]), and inability to feed oneself (HR = 4.78, 95% CI = 4.30, 5.31) was associated with shorter time to discharge to hospice. Symptoms of anxiety daily (HR = 1.55 [95% CI = 1.43–1.68]), and pain daily or all the time (HR = 1.54 [95% CI = 1.43–1.64]) were associated with shorter time to discharge to hospice. Conclusions: High symptom burden, ADL dependency, and cognitive impairment on admission to HHC services was associated with greater likelihood of discharge to hospice.

“The Crossover to Hospice”: Perspectives of Home Healthcare Nurses and Social Workers

“…Interviews were guided by a semi structured, open-ended questionnaire informed by Donabedian’s theoretical framework 21 and prior research about hospice use in HHC. 17,22 Participants were asked questions specific to processes of care (e.g., “How do you identify patients who may need hospice?” as well as those related to outcomes (e.g., “Tell me about your interactions with your patients or their families when you initiate the conversation about hospice?” Sociodemographic data including age, gender, race, and years of HHC experience were collected following the semi-structured interview. Each interview lasted 30 to 45 minutes.…”

“…16 Given the large number of Medicare beneficiaries who utilize HHC annually, the role of HHC in shaping transitions to hospice for older adults in the community is gaining attention. 17,18 To our knowledge, however, no study has examined how discussions about hospice, or referrals to hospice, between patients and nurses or social workers occur in the HHC setting. To fill this gap, we sought to explore perspectives on transition from HHC to hospice among HHC nurses and social workers.…”

Black Americans, hospitalization, and advance care planning: Structural vulnerability in Home Health Value-Based Purchasing

“…2,3 Medicare beneficiaries in the HH setting constitute a vulnerable population: Most are ≥85 years old, and, when compared to non-Medicare beneficiaries, have more functional impairments, have lower income, and are more likely to live alone. 4 In addition, Black Americans experience structural vulnerability: Overlapping hierarchies of power that constrain access to healthcare and frame choices that impact health outcomes. 5 An example of a choice that impacts health outcomes is advance care planning (ACP), where preferences about future end-of-life treatments are discussed.…”

Nurse–Social Worker Teams

“…Home healthcare (HHC) nurses work largely in professional silos. This model is not sustainable given the increase in acuity of home care patients, many with advanced illness and high symptom burden (Bowles et al, 2021; Falvey et al, 2020; Jones et al, 2019; Osakwe et al, 2022). The current nursing workforce shortage poses a major challenge to the HHC sector that relies heavily on nurses for clinical visits, care coordination, and home health aide supervision (Buerhaus et al, 2022; Irani et al, 2018).…”