March 23 (UPI) -- A study found only slight differences in the intensity of hospice services between nursing homes, assisted living centers and in-home care.
Researchers from the Indiana University Center for Aging Research and the Regenstrief Institute analyzed data from more than 32,600 men and women in 18 states who received routine hospice care between 2009 and 2015. About 43 percent of participants had hospice care for less than two weeks and 20 percent were in hospice care for more than six months.
"It has been a concern that patients who live in nursing homes or assisted living facilities may be getting potentially less hospice care than people receiving hospice care at home," Dr. Kathleen Unroe, assistant professor of medicine at the IU School of Medicine, said in a press release. "We found that not to be the case. However, while the intensity of hospice services across settings was quite similar, people living at home were more likely to get more hospice nurse care, while those living in nursing homes or in assisted living facilities received more hospice aide care across hospice episode."
Unroe said that differences in diagnosis might be behind the difference in service.
"This difference in service mix may be explained at least in part by differences in diagnoses," Unroe said. "A patient with a lot of medical complexity who is living at home requires more nurse visits. Individuals with advanced dementia who live in assisted living facilities or nursing homes may require more hospice aide assistance to keep them comfortable in the terminal phase of that disease. An overall 'U-shaped curve' of service intensity was found for all three site types and overall multiple lengths of stay."
The study found the median length of hospice care for assisted living facility residents was 42 days compared to 19 days for nursing home residents and 17 days for patients living at home. Patients living in assisted living facilities were older and more likely to have dementia as their terminal diagnosis compared to nursing home residents and in-home hospice patients.
"Use of hospice services is growing dramatically," Unroe said. "Our study reports on a large sample of hospice patients. Our findings will provide important baseline data as we and others analyze how the changes in government payment methodology -- made in 2016 for the first time in decades -- may impact a whole range of aspects of hospice care including intensity of services provided and lengths of stay."