• Courtney Harold Van Houtven, Donald H Taylor, Karen Steinhauser, and James A Tulsky.
• Center for Health Services Research and Development in Primary Care, VA Medical Center, Durham, North Carolina 27705, USA. courtney.vanhoutven@duke.edu
• J Palliat Med. 2009 Aug 1; 12 (8): 687-94.

ObjectiveTo test whether the presence of an informal or formal care network in the home leads to different hospice utilization patterns near death. To examine how the informal care relationship affects hospice use patterns.Data SourcesMedicare Current Beneficiary Survey (MCBS), 1997-2001.Study DesignUsing logistic regression and ordinary least squares, we examine the association between a person's in-home network of care and the use of Medicare hospice services in the last year of life. We also examine whether the care-dyad relationship is associated with different hospice use patterns.Data ExtractionAll individuals in the MCBS who lived at home at the time of the interview and who died between 1998 and 2001, 1404 persons.Principal FindingsPeople receiving formal home care had a much higher chance of enrolling in hospice prior to death. Informal care did not influence the likelihood of hospice but was associated with longer use among hospice users. Daughter caregivers increased the likelihood and duration of hospice use whereas sons significantly decreased the likelihood.ConclusionsBecause formal care is associated with increased use of hospice, future work should examine whether patients without an in-home network faced access barriers. Caregiver relationships had large effects on length of hospice stays, yet we do not know whether changes moved a patient closer to or further away from their optimum use of the benefit.

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