Access to Medicare Hospice for Nursing Home Residents

摘要

The main goal of this study was to explore the factors influencing access to hospice care for dying nursing home (NH) residents and gain knowledge that would lead to an R01 proposal addressing this topic. We evaluated which population and organizational structure characteristics of the NH and hospice providers are instrumental in the observed higher access barriers faced by NH residents. To achieve this we created geocoding variables (latitudel/longitude) for NHs and hospice providers that allowed us to explore the extent of the hospice market in a NH setting. We also evaluated which patient, provider and market factors are associated with the choice of hospice by a given NH resident. Our findings show that after adjusting for patient, provider and market factors some facility characteristics such as for-profit status that appeared to be associated with higher access to hospice are not significantly associated$ however NH with higher percent of non-white NH residents have lower number of residents choosing hospice and NH with a special care unit have higher number of residents choosing hospice. We also found evidence that distance from the NH to the nearest hospice provider in excess of 15 miles is associated with significantly lower access to hospice care. The RO1 proposal that was submitted at the end of the project period received funding from AHRQ on 9-30-2003 (RO1 HS13355-01 Al) to conduct a national-level study of the effects of provider and market factors on access to hospice in NHs.