State Regulations and Hospice Utilization in Assisted Living During the Last Month of Life.
Emmanuelle Belanger, Joan M Teno, Xiao Joyce Wang and 4 others
PMID 34971591WHAT IT FOUND
Dying residents in assisted living were more likely to receive hospice care when state regulations explicitly allowed it.
This link held even after accounting for patient age, dementia, and local hospital patterns, suggesting regulatory clarity helps patients access end-of-life services in their homes.
Key findings
01Residents in assisted living settings with regulations explicitly supporting hospice were significantly more likely to receive hospice care in the last month of life than those in settings without such explicit policies.
02State requirements for registered nurse staffing did not significantly change the overall likelihood of receiving hospice care, though they were associated with lower use of high-intensity continuous home care.
03The vast majority of residents who received high-intensity continuous home care remained in assisted living until death, whereas those without hospice often transferred to other settings without receiving hospice there.
STILL TO COME
How it was doneWhat they foundWhat it means for RNs
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What it does not show
The study cannot prove that regulations caused increased hospice use; it is possible that areas with strong hospice advocacy pushed for these regulations. The analysis excluded small, home-like residential care settings, so findings may not apply to those environments. The data did not capture the quality of care or symptom management, only the presence of services. Some beneficiaries living in independent living units at the same address as assisted living facilities may have been included in the cohort.
Declared interests
The authors declared no conflicts of interest. The study was supported by the National Institute on Aging.
The easy way to misread this
Do not assume that simply having registered nurses on staff guarantees better access to intensive end-of-life care. The study found that facilities with RN staffing requirements actually used less high-intensity continuous home care, suggesting that regulatory policies explicitly allowing hospice, rather than just staffing mandates, are the key driver for accessing these specific services.