Table 2.
Factors Associated with Hospice Enrollment of Nursing Home Patients*
| Variable | OR (95% CI) |
|---|---|
| (R) NH residents attributes | |
| Sociodemographics | |
| Male | 0.80 (0.77, 0.84)‡ |
| Nonwhite | 0.90 (0.83, 0.97)‡ |
| Married | 1.13 (1.08, 1.18)‡ |
| Age, per year | 0.99 (0.98, 0.99)‡ |
| Diagnosis group | |
| Other | 1.00 |
| Cancer, no dementia | 3.21 (3.03, 3.41)‡ |
| Cancer, with dementia | 2.29 (2.14, 2.46)‡ |
| Dementia | 1.05 (1.00, 1.11)† |
| Additional diagnoses | |
| Congestive heart failure | 0.89 (0.85, 0.93)‡ |
| Chronic obstructive pulmonary disease | 0.99 (0.94, 1.04) |
| Activities of daily living (per unit increase) | 0.97 (0.95, 0.99)† |
| Cognitive performance scale (per unit increase) | 0.95 (0.94, 0.96)‡ |
| Advance directive | |
| Do-not-hospitalize order | 1.34 (1.21, 1.49)‡ |
| Do-not-resuscitate order | 1.30 (1.24, 1.36)‡ |
| Resource utilization | |
| NH stay < 90 days | 1.03 (0.98, 1.09) |
| Number of hospitalizations 6 months before hospice MDS | 1.08 (1.06, 1.09)‡ |
| Days from MDS assessment to date-of-death (months) | |
| < 3 | 1.00 |
| 3≤6 | 1.59 (1.49, 1.70)‡ |
| 6+ | 1.49 (1.39, 1.60)‡ |
| (F) NH facility attributes | |
| NH of patient | |
| Average nursing case-mix index (per 0.1 units increase) | 1.04 (1.02, 1.07)‡ |
| Percent nonwhite residents in NH (per 1% increase) | 0.65 (0.44, 0.95)† |
| Percent Medicaid-pay residents in NH (per 10% increase) | 1.00 |
| Percent Medicare-pay residents in NH (per 10% increase) | 1.02 (0.98, 1.06) |
| Percent private-pay residents in NH (per 10% increase) | 1.03 (1.00, 1.06)† |
| For-profit | 1.01 (0.87, 1.18) |
| Part of a chain | 1.09 (0.96, 1.23) |
| Operated by a hospital | 0.98 (0.76, 1.23) |
| Number of health deficiencies (per unit increase) | 1.00 (0.99, 1.00) |
| Presence of any special care unit | 1.10 (0.99, 1.22)† |
| Distance from NH to nearest hospital (miles) | |
| < 2 | 1.00 |
| 2≤6 | 1.09 (0.96, 1.24) |
| 6+ | 1.02 (0.88, 1.19) |
| Nearest hospital size is large (250+ beds) | 1.21 (1.02, 1.43)† |
| More than two hospitals within 10 miles | 1.03 (0.87,1.23) |
| Nearest hospice provider | |
| For-profit | 0.96 (0.75, 1.23) |
| Operated by a hospital | 1.00 |
| Operated by free-standing program | 0.91 (0.78, 1.06) |
| Operated by a home health agency | 0.79 (0.67, 0.93)† |
| Operated by government | 0.69 (0.55, 0.86)‡ |
| Operated by a SNF | 0.51 (0.38, 0.70)‡ |
| Respite care provided | 1.00 |
| Acute/inpatient care only provided | 0.78 (0.66, 0.92)‡ |
| Hospice and NHH both for-profit | 1.58 (1.23, 2.02)‡ |
| For-profit hospice and NHH part of a chain | 1.03 (0.82, 1.30) |
| Distance from NH to closest hospice (miles) | |
| < 15 | 1.00 |
| 15≤30 | 0.88 (0.72, 1.07) |
| 30+ | 0.49 (0.32, 0.73)‡ |
| Additional distance from NH to second closest hospice (miles) | |
| < 15 | 1.00 |
| 15≤30 | 1.06 (0.89, 1.26) |
| 30+ | 0.90 (0.67, 1.20) |
| More than two hospices within 10 miles | 0.98 (0.82, 1.17) |
| (M) Local health care market and states | |
| Number of hospital beds in the county (per 100 aged ≥65) | 0.96 (0.93, 1.00) |
| Number of NH beds in the county (per 100 aged ≥65) | 1.05 (1.03, 1.07)‡ |
| Number of medical doctors in the county (per 100 aged ≥65) | 1.13 (1.06, 1.21)‡ |
| Maine | 1.00 |
| New York | 2.23 (1.60, 3.11)‡ |
| Ohio | 4.51 (3.29, 6.18)‡ |
| Kansas | 4.16 (2.97, 5.82)‡ |
| South Dakota | 2.18 (1.35, 3.50)‡ |
*
The table shows the results of a generalized estimating equation logistic regression giving the ORs and 95% CIs of electing Medicare's hospice depending on patient, NH, hospice provider, local health market, and state attributes in a sample of 183,742 NH residents. CIs were adjusted to account for natural clustering of patients into NHs. All dichotomous variables were coded as 1 = present and 0 = absent. Reference categories are denoted with an OR of 1.00 and no 95% CIs
†
p < 0.05
‡
p < 0.001
MDS, minimum data set assessment of NH residents; SNF, skilled nursing facility; NH, nursing home; OR, odds ratio; CI, confidence interval.