Clinical Course of Hospice Patients in Nursing Homes Difficult to Predict

​The clinical course of hospice patients living in nursing homes is difficult to predict, reports a study in the Journal of the American Medical Directors Association. The researchers retrospectively reviewed Medicare and Medicaid claims and Minimum Data Set assessments for 33,387 people age 65 or older who had had at least one clinical encounter with a public health system in an urban Midwestern city. The study found that between 1999 and 2008, 1,452 individuals (4% of the entire sample) received hospice services while in a nursing home for at least part of their hospice stay. The mean length of hospice stay among nursing home residents remained high throughout the study period (114 days). However, wide variability was noted: Although 20% had stays longer than six months, 48% had stays shorter than 30 days. In addition, 18% disenrolled from hospice before death. Although 79% of beneficiaries were already living in the nursing home when they enrolled in hospice and remained in the nursing home thereafter, several other patterns were observed.