Hospice Care May Start Later for Assisted Living Residents

New research from the Journal of the American Geriatric Society has found that, for some, hospice care may start closer to the end of life for those in assisted living facilities than for those receiving care at home. Residents living in facilities may also be less likely to receive opiate painkillers to ease discomfort in their final days.

On average, it is estimated that about 1.6 million Americans annually receive hospice care, which focuses on quality of life rather than continuing attempts to treat disease. Most receive hospice care in their homes, with only about 7% living in residential facilities such as assisted living settings. However, it is estimated that by 2050, over 27 million people will be aged 65 and older in the United States, many of whom will be housed in assisted living facilities (https://bit.ly/1ejEQYG).

The study analyzed the differences in hospice care among individuals living at home and those in assisted living facilities. The researchers reviewed the records for 12 nonprofit hospice centers in New Mexico, California, Pennsylvania, Wisconsin, Michigan, Ohio, Florida, Texas, Kentucky, Kansas, and Missouri. From 2008 to 2012, 78,130 of the patients in the study lived at home, and 7451 were in assisted living. The latter were typically older and more likely to be female and have dementia, a disability, or a history of at least one previous stroke.

Hospice stays in assisted living centers tended to be shorter, lasting no more than 24 days for half of the assisted living patients, compared with the length of hospice care in-home, which lasted up to 29 days for half of the in-home patients. Although pain was common in both groups, patients receiving care at home were twice as likely to receive opiates. In general, patients with cancer were more likely to receive painkillers, and white and older patients were less likely to receive them.

The authors acknowledged that patients’ pain levels, as well as their preferences for where to live during their final days, were not evaluated. Additionally, the study does not reveal whether the two types of settings differed in the quality of other methods of pain management, such as music or message therapy.

The study concluded that there were indeed several profound differences between hospice care at home and hospice care in an assisted living facility. Obtaining a greater understanding of the nature of these differences would help hospices develop better coordination of end-of-life care for the assisted living population. —Sean McGuire