Hospice care in assisted living facilities versus at home: Results of a multisite cohort study

Objectives To compare residents of assisted living facilities receiving hospice with people receiving hospice care at home. Design Electronic health record-based retrospective cohort study. Setting Nonprofit hospices in the Coalition of Hospices Organized to Investigate Comparative Effectiveness network. Participants Individuals admitted to hospice between January 1, 2008, and May 15, 2012 (N = 85,581; 7,451 (8.7%) assisted living facility, 78,130 (91.3%) home). Measurements Hospice length of stay, use of opioids for pain, and site of death. Results The assisted living population was more likely than the home hospice population to have a diagnosis of dementia (23.5% vs 4.7%; odds ratio (OR) = 13.3, 95% confidence interval (CI) = 12.3-14.4; P <.001) and enroll in hospice closer to death (median length of stay 24 vs 29 days). Assisted living residents were less likely to receive opioids for pain (18.1% vs 39.7%; OR = 0.33, 95% CI = 0.29-0.39, P <.001) and less likely to die in an inpatient hospice unit (9.3% vs 16.1%; OR = 0.53, 95% CI = 0.49-0.58, P <.001) or a hospital (1.3% vs 7.6%; OR = 0.16, 95% CI = 0.13-0.19, P <.001). Conclusion Three are several differences between residents of assisted living receiving hospice care and individuals living at home receiving hospice care. A better understanding of these differences could allow hospices to develop guidelines for better coordination of end-of-life care for the assisted living population.