Friday, December 10, 2010
The Long and Short of Hospice Time in Nursing Homes (Research)
As a hospice volunteer in Detroit nursing homes, I have had hospice patients stay as short as one day and as long as three years. With little quiet or privacy, almost all of them shared rooms with one to three non-hospice residents. My three-year patient was 94 years old. Having few visits from relatives and friends who lived out of town, her biggest fear was the possibility of being released from hospice care and the nursing home. I’ve also had rare happy patients who were released from hospice because their health improved.
One patient with dementia seemed to have a premonition that she would be leaving soon when she said to me one day, “I was wondering if you could help me find another apartment. I’ve been thinking about looking for a new place to stay, maybe a place closer to where I used to live. This apartment building is too noisy. Just close your eyes and listen to all the talking, buzzers, and everything. People come into my place without even knocking. They just walk right in and go through my closet and drawers. It’s not right. Three ladies even moved in with me when I wasn’t looking. Now, I can’t get them out.” I had never heard her say anything about leaving before. Two weeks later, she was released from hospice care and moved to a nursing home near her son’s house.
Are there characteristics of nursing homes and residents that are associated with long and short hospice stays? Using 13,479 residents enrolled in hospice care, researchers at Harvard Medical School looked for answers to this question. Research results indicated the following:
1) Nursing home characteristics were not statistically significant predictors of long stays.
2) The probability of a short stay increased with the facility's nurse staffing ratio and decreased with the share of residents covered by Medicaid.
3) Men (relative to women) and blacks (relative to whites) were less likely to have a long stay and more likely to have a short stay.
4) Those 70 years or younger (relative to those 81-90) and residents with Alzheimer's disease/dementia were more likely to have long stays and less likely to have short stays.
5) Fourteen percent of hospice users were discharged before death because they failed to meet Medicare hospice eligibility criteria. These residents on average had longer lengths of stays.
If you work with hospice patients in nursing homes, have you noticed these occurrences? Researchers concluded “high rates of discharge before death that may reflect a less predictable life trajectory of nursing home residents suggests that further evaluation of the hospice benefit for nursing home residents may be needed.”
Frances Shani Parker, Author