State Variability in Assisted Living Residents' End-of-Life Care Trajectories.
Kali S Thomas, Emmanuelle Belanger, Wenhan Zhang and 1 others
PMID 31704224WHAT IT FOUND
Assisted living residents who died in 2016: 57% died outside hospitals or nursing homes, but hospice use and transfers varied widely by state; dual eligible residents were more likely to die in nursing homes or hospitals.
Key findings
01Of 40,359 assisted living decedents in 2016, 57% died outside a hospital or nursing home, and 18,396 received hospice at the time of death.
02In the last 30 days of life, hospice use rose from 20% to 46%, hospitalization rose from 6% to 16%, and nursing home transition rose from 25% to 27%.
03Days spent in assisted living and receiving hospice varied widely by state, from 24 days in Utah to fewer than 14 days in North Dakota, and from 13+ days in Utah to fewer than 3 days in North Dakota.
STILL TO COME
How it was doneWhat they foundWhat it means for RNs
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What it does not show
Only large assisted living communities with 25 or more beds were included, so results may not apply to small assisted living settings. Residence was identified by ZIP code, which may include people in co-located independent living settings rather than assisted living. The study looked only at Medicare beneficiaries who died in 2016, and it excluded Medicare Advantage enrollees and residents not enrolled in Medicare, so it misses part of the assisted living population. Claims data describe where care was delivered and whether hospice was used, not the quality of end-of-life care or whether it matched residents' preferences. Alzheimer's disease and related dementia may be underdiagnosed and varies by state, limiting dementia-specific interpretation. The study did not examine hospice practice patterns or local market factors, such as availability of nursing home or inpatient beds, which may explain some differences. The study did not test which state regulations caused the observed differences in assisted living and hospice days.
Declared interests
The authors declared no conflicts of interest. The article is listed as supported by NIH extramural and U.S. government non-P.H.S. research support.
The easy way to misread this
Do not read the hospice and place-of-death patterns as proof that assisted living end-of-life care was high quality or matched residents' preferences. The study used administrative claims and could not assess quality or preferences.