2008 Grants - Miller

End-of-Life Care and Hospice: Older Adults with Dementia in Nursing Homes

Susan C. Miller, Ph.D.
Brown University
Providence, Rhode Island

2008 Investigator-Initiated Research Grant

In 2001, 67 percent of older adults with dementia who died did so in a nursing home, yet we know little about this experience. Of particular interest is how hospice use and outcomes vary for people who entered nursing homes under Medicare's skilled nursing facility benefit.

Medicare policy does not allow simultaneous access to both hospice and skilled nursing home benefits. However, 12 percent of these adults who entered skilled nursing facilities died within 90 days of arrival. An Alzheimer's Association study said this barrier to simultaneous Medicare benefits is the foremost public policy barrier to palliative care among residents of nursing homes who have dementia.

Susan C. Miller, Ph.D., and colleagues will create a national population-based database by looking at nursing home residents over the age of 65 with dementia who died between 1999 and 2005.

The team will assess the rate and length of Medicare hospice care for people by state and the rate and length of hospice care for people with and without skilled nursing facility benefits in the last 90 days of life. The researchers will also analyze the effects of hospice care on key palliative outcomes, such as dying in the hospital and persistent pain, for people with skilled nursing facility benefits in the last 90 days of life. Finally, they will determine whether these outcomes differed if the person used nursing home hospice care.

The study will improve understanding of the use of hospice care in nursing homes for people with dementia. The results will also provide important information to policy makers on how the Medicare policy on simultaneous skilled nursing home and hospice benefits is associated with end-of-life hospitalizations and quality of care.