The Influence of Hospice Use on Nursing Home and Hospital Use in Assisted Living Among Dual-Eligible Enrollees

Race, Any Cancer, Income, or Cognitive Function

“…Similar to studies conducted in assisted-living 14 and nursing-home settings, 6,15,16 we found that hospice use significantly decreased the risk of hospitalizations, ICU/CCU admissions, and ED visits at the end of life. These findings are perhaps not unexpected since a condition of the hospice benefit is that patients forego other Medicare-covered benefits to treat their terminal illness.…”

“…Three studies that examined the increased use of aggressive care at the end of life included only patients with cancer, 11-15 and only one of these studies examined the effects of race. 11 Another study focused on assisted-living residents only 14 while other studies were conducted among residents of nursing homes and limited the outcome of interest to hospitalizations 6,15,16 Further, every study defined end of life as the last 30 days of life and did not examine the use of aggressive services prior to that period. Most importantly, none of these studies examined use of aggressive services in the last 12 months of life nor controlled for the covariates such as income, neighborhood SES, cognitive, and physical function in a single study.…”

Elevated Hospitalization Risk of Assisted Living Residents With Dementia in Alberta, Canada

“…34 Preliminary data suggest that increasing the availability of palliative care services within the AL sector may significantly reduce the likelihood of hospitalization and LTC admissions. 38 While the relationship between medication use and hospitalization risk may reflect the number of drugs acting as a marker of comorbidity and/or illness severity, many hospital admissions of older individuals are drug-related. 65 Optimizing medication prescription and administration in AL, particularly for frail residents with self-care and/or communication difficulties, have been highlighted as key areas requiring improvement.…”

Comparing frailty measures in their ability to predict adverse outcome among older residents of assisted living

“…In earlier work we failed to observe a statistically significant increase in the risk of hospitalization among frail men that we felt was due to their high mortality rate during follow-up [14]. Other considerations would include the inherent difficulty of predicting hospitalizations especially for catastrophic (e.g., fall with a hip fracture) changes in health, the modifying effects of factors such as advance planning and the resources available within AL facilities [32], and the obscuring influence of variability in local hospitalization rates [33]. …”