• Debra Jean Dobbs, Laura Hanson, Sheryl Zimmerman, Christianna S Williams, and Jean Munn.
• University of South Florida, School of Aging Studies, University of South Florida, Tampa, Florida 33620, USA. ddobbs@cas.usf.edu
• J Palliat Med. 2006 Dec 1; 9 (6): 1388-400.

ObjectivesTo examine the attitudes of residential care/assisted living (RC/AL) and nursing home (NH) administrators toward hospice and to assess facility and administrator characteristics related to those attitudes.DesignTwo exploratory factor analyses of the Hospice Attitudes Questionnaire using principal factors with a promax (oblique) rotation were conducted. One was in a sample of 390 RC/AL and NH administrators from four states (Florida, Maryland, North Carolina, and New Jersey) and the other included NHs from this and a second sample (n = 244). Association between facility and administrator characteristics and administrator attitudes towards hospice were examined among the 146 RC/AL administrators.ResultsExploratory factor analysis in the full sample resulted in the 12-item Long-Term Care Hospice Attitudes Scale (LTC-HAS) with four component subscales: (1) emotional and spiritual support (three items, alpha = 0.83); (2) quality of care (four items, alpha = 0.78); (3) rapidity of death (three items, alpha = 0.66) and (4) end-of-life care coordination (two items, alpha = 0.73). The overall alpha for the 12-item scale was 0.81. When exploratory factor analysis was conducted on the NH data only, a three-item subscale related to financing and billing (alpha = 0.66) also emerged. Four facility and three administrator characteristics that were significantly related to hospice attitudes included state, facility type, facility age, affiliation with another level of care; and age, race, and nurse training.ConclusionFindings from this paper provide insight about RC/AL facility and NH administrators' attitudes towards Hospice using scale data, an area with limited research. They indicate positive attitudes toward Hospice care coordination, and that Hospice should supplement, as opposed to replace, the care provided by facilities. Findings also suggest areas where targeted outreach and further study may be recommended.

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