Government Expenditures at the End of Life for Short- and Long-Stay Nursing Home Residents: Differences by Hospice Enrollment Status

Authors

  • Susan C. Miller PhD,

    1. From the *Center for Gerontology and Health Care Research and Department of Community Health, Brown University School of Medicine, Providence, Rhode IslandDivision of Economic, Social and Administrative Pharmacy, College of Pharmacy and Pharmaceutical Sciences, Florida A & M University, Tallahassee, Florida.
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  • Orna Intrator PhD,

    1. From the *Center for Gerontology and Health Care Research and Department of Community Health, Brown University School of Medicine, Providence, Rhode IslandDivision of Economic, Social and Administrative Pharmacy, College of Pharmacy and Pharmaceutical Sciences, Florida A & M University, Tallahassee, Florida.
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  • Pedro Gozalo PhD,

    1. From the *Center for Gerontology and Health Care Research and Department of Community Health, Brown University School of Medicine, Providence, Rhode IslandDivision of Economic, Social and Administrative Pharmacy, College of Pharmacy and Pharmaceutical Sciences, Florida A & M University, Tallahassee, Florida.
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  • Jason Roy PhD,

    1. From the *Center for Gerontology and Health Care Research and Department of Community Health, Brown University School of Medicine, Providence, Rhode IslandDivision of Economic, Social and Administrative Pharmacy, College of Pharmacy and Pharmaceutical Sciences, Florida A & M University, Tallahassee, Florida.
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  • Janet Barber PhD,

    1. From the *Center for Gerontology and Health Care Research and Department of Community Health, Brown University School of Medicine, Providence, Rhode IslandDivision of Economic, Social and Administrative Pharmacy, College of Pharmacy and Pharmaceutical Sciences, Florida A & M University, Tallahassee, Florida.
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  • Vincent Mor PhD

    1. From the *Center for Gerontology and Health Care Research and Department of Community Health, Brown University School of Medicine, Providence, Rhode IslandDivision of Economic, Social and Administrative Pharmacy, College of Pharmacy and Pharmaceutical Sciences, Florida A & M University, Tallahassee, Florida.
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  • This project was funded by the Agency for Healthcare Research and Quality, Department of Health and Human Services (1 R01 HS10549) and in part by the Open Society Institute's Project Death in America Faculty Scholar Program. Presented at the Gerontological Society of America's 2002 Annual Meeting.

Address correspondence to Susan C. Miller, PhD, Center for Gerontology and Health Care Research, Brown University, 2 Stimson Street, 2nd Floor, Providence, RI 02919. E-mail: Susan_Miller@brown.edu

Abstract

Objectives: To examine end-of-life government expenditures for short- and long-stay Medicare- and Medicaid-eligible (dual-eligible) nursing home (NH) hospice and nonhospice residents.

Design: A retrospective cohort study.

Setting: Six hundred fifty-seven Florida NHs.

Participants: Dual-eligible NH residents who died in Florida NHs between July and December 1999 (N=5,774).

Measurements: Nursing home stays of 90 days or less were considered short stays (n=1,739), and those over 90 days were long stays (n=4,035). Three diagnosis groups were studied: cancer without Alzheimer's disease or dementia, Alzheimer's disease or dementia, and other diagnoses. Eligibility and expenditure claims data for 1998 and 1999 were merged with vital statistics and NH resident assessment data to determine diagnoses, location of death, hospice enrollment, eligibility, and expenditures.

Results: Twenty percent of short-stay (n=350) and 26% of long-stay (n=958) NH decedents elected hospice; of these, 73% of short-stay and 58% of long-stay NH residents had hospice stays of 30 days or less. Overall, mean government expenditures in the last month of life were significantly less for hospice than nonhospice residents ($7,365; 95% confidence interval (CI)=$7,144–7586 vs $8,134; 95% CI=$7,896–8,372), but 1-month expenditures were only significantly lower for hospice residents with short NH stays, not for those with long NH stays.

Conclusion: Overall, hospice care in NHs does not appear to increase government expenditures. Because significantly lower expenditures are observed for short-stay NH hospice residents, policy restricting access to Medicare hospice for Medicare skilled nursing facility residents may represent a missed opportunity for savings.

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