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U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES Centers for Disease Control and Prevention. Hospice and Palliative/End of Life Care in Nursing homes. Robin E. Remsburg, PhD, APRN, BC Beth Han, PhD, MD, MPH National Center for Health Statistics. Introduction (1).

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slide1

U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES

Centers for Disease Control and Prevention

Hospice and Palliative/End of Life Care in Nursing homes

Robin E. Remsburg, PhD, APRN, BC

Beth Han, PhD, MD, MPH

National Center for Health Statistics

introduction 1
Introduction (1)
  • Hospice, a form of end-of-life care, emphasizes comfort, pain relief, and emotional and spiritual support.
  • Hospice care in nursing homes offers a collaborative opportunity for nursing homes and hospices to provide end-of-life care to nursing home residents, including high-quality pain and other symptoms management.
  • About 76% of nursing homes in the U.S. contracted with hospices in 2000.
  • Less than 5% of those who died in nursing homes in 1997-1998 received hospice care based on data from either the National Center for Health Statistics or the National Hospice and Palliative Care Organization.
  • About 25% of the Americans who died in 2000 were under hospice care at the time of death.
introduction 2
Introduction (2)
  • Providers face challenges in coordination and care planning for hospice and EOL patients in nursing homes, including
      • high staff turnover and limited hospice/EOL training among nursing home staff;
      • cultural and philosophical differences between hospices and nursing homes;
      • Medicare nursing home regulations and reimbursement rules which encourage skilled nursing care over the Medicare Hospice Benefit programs.
purposes
Purposes

The purposes of this study are:

  • To estimate the prevalence of skilled nursing homes with special programs and trained staff for hospice and EOL care in the U.S.
  • To examine facility characteristics associated with skilled nursing homes with special programs and trained staff for hospice.
methods 1
Methods (1)
  • Study Population and Survey
      • Data from 2004 National Nursing Home Survey
      • Cross-sectional study
      • Nationally representative data on hospice, palliative/end of life care
      • Universe of approximately 17,000 nursing homes
        • Licensed by the state; 3 or more beds
      • Sample of 1,500 nursing homes
      • A total of 1,174 nationally representative nursing homes were examined.
      • Data collection methods
        • In-person interview
        • Administrator
        • Staff informant
        • Medical and facility records
question
Question

Please tell me if this facility has a special program that has specially trained personnel dedicated to the program for anything listed on this card.

  • Hospice
  • Palliative/End of Life Care/Terminal Condition-Not hospice
  • Pain management
  • ………
methods 2
Methods (2)
  • We examined
    • ownership status
    • chain affiliation
    • bed size
    • formal contract for hospice
    • characteristics of top management (administrator, DON, medical director)
    • region
    • MSA status
    • percentage of Medicaid residents
    • medical care
    • staffing stability
  • Cochran-Mantel-Haenszel tests at the bivariate level and multivariate logistic regression modeling were used.
  • SUDAAN software was used to adjust for the complex sampling design and sampling weights.
preliminary result 1
Preliminary Result (1)
  • In 2004, 78% (95% CI: 76%-80%) of nursing homes had formal contracts with outside hospice programs
  • 26% (95% CI: 24%-28%) of nursing homes had special programs and trained staff for pain management
  • 19% (95% CI: 17%-21%) of nursing homes had special programs and trained staff (SPTS) for hospice
  • 17% (95% CI: 15%-19%) of nursing homes had special programs and trained staff for palliative/end of life care
slide9

Facility characteristics associated with special programs and trained staff for hospice: Bivariate analysis

slide11
Facility characteristics associated with nursing homes with special programs and trained staff for hospice care: Multivariate analysis
discussion
Discussion
  • Strengths
    • Nationally representative data
    • New information on EOL care
  • Limitations
    • Facility report
    • No information on personnel or training (e.g., ELNEC)
summary
Summary
  • Preliminary analyses indicate that not-for-profit ownership status, formal contract with outside hospice, special programs and trained staff for pain management and behavior management, physician(s) (non-medical director) on staff, medical director who works four days, and being located in South are associated with having a special program and trained staff on hospice care.
implications
Implications
  • These data provide some insight into ways end of life care is being provided in nursing homes that may beyond traditional hospice care
  • Physician involvement may be important in establishing EOL care programs/practices
  • Nursing home residents can present special care giving challenges, e.g., symptom and pain management in residents with dementia; specially trained staff and special may be a way to meet these special needs
  • More recent approaches to EOL care include blending of aggressive and palliative care; special training and programs may be a way to address this new care approach