Hospice Care in Assisted Living Facilities Versus at Home: Results of a Multisite Cohort Study

ObjectivesTo compare residents of assisted living facilities receiving hospice with people receiving hospice care at home. DesignElectronic health record-based retrospective cohort study. SettingNonprofit hospices in the Coalition of Hospices Organized to Investigate Comparative Effectiveness network. ParticipantsIndividuals 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). MeasurementsHospice length of stay, use of opioids for pain, and site of death. ResultsThe 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 29days). 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). ConclusionThree 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.