Exploring Variations in Hospice Use and Palliative Care in Nursing Homes

Over the past decade there has been a substantial expansion of hospice care in the nursing home setting. Now, over ¾ of nursing homes have had at least some involvement with hospice providers. The quality of those relationships varies substantially, both as reflected by the volume of referrals to hospice and qualitative observations of inter-organizational relations. However, some nursing homes have chosen to meet their terminal residents’ needs by building their own palliative care service capacity. Theoretically, all other things being equal, this decision to buy (hospice) or build (palliative care capacity) is influenced by the volatility and uncertainty resulting from the policy and market environment in which the nursing home is located. The Variations in Hospice Use project, headed by Vince Mor, PhD and Susan Miller, PhD, extends previous and ongoing work by using nursing home resident assessment data, nursing home provider data, hospice provider data, market level data, and state policy data to understand how state policies affect hospice use and the level of nursing home investment in end of life palliative care. The ultimate goal of this project is to positively influence the quality of end of life care in nursing homes by disseminating knowledge on how state policies are associated with nursing home choices about providing end of life palliative care and how these choices are associated with nursing home care processes.