• Haiden A Huskamp, David G Stevenson, David C Grabowski, Eric Brennan, and Nancy L Keating.
• Department of Health Care Policy, Harvard Medical School, Boston, MA 02115, USA. huskamp@hcp.med.harvard.edu
• J Palliat Med. 2010 Aug 1; 13 (8): 957-64.

ObjectiveTo identify characteristics of nursing homes and residents associated with particularly long or short hospice stays.Design/SettingObservational study using administrative data on resident characteristics and hospice utilization from a large regional hospice linked with publicly available data on nursing home characteristics.ParticipantsA total of 13,479 residents who enrolled in hospice during 2001-2008.MeasurementsLogistic regression models of the probability of a long (>180 days) or very short (ResultsNursing home characteristics were not statistically significant predictors of long stays. The probability of a short stay increased with the facility's nurse staffing ratio and decreased with the share of residents covered by Medicaid. Men (relative to women) and blacks (relative to whites) were less likely to have a long stay and more likely to have a short stay, while those 70 years or younger (relative to those 81-90) and residents with Alzheimer's disease/dementia were more likely to have long stays and less likely to have short stays. Fourteen percent of hospice users were discharged before death because they failed to meet Medicare hospice eligibility criteria, and these residents had longer lengths of stay, on average.ConclusionFew facility characteristics were associated with very long or very short hospice stays. However, high rates of discharge before death that may reflect a less predictable life trajectory of nursing home residents suggests that further evaluation of the hospice benefit for nursing home residents may be needed.

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