Access to nursing home hospice: Perspectives of nursing home and hospice administrators

Background and objectives: Hospice improves the quality of end of life care in nursing homes but serves less than 10% of dying residents. For residents to elect hospice, nursing homes must first contract for these services. We surveyed nursing home and hospice administrators to describe facilitators and barriers to hospice in nursing homes, and to test whether nursing home administrators' attitudes correlate with hospice use. Methods: In a mailed survey, all nursing home and hospice administrators in North Carolina responded to items on hospice's effect on quality of care, and on facilitators and barriers to its use in nursing homes. Among nursing home administrators, bivariate analyses were used to test associations of attitudes with use of hospice. Results: After 2 mailings, 241 (62%) nursing home administrators and 74 (85%) hospice administrators responded. Eighty-three percent of nursing homes had a hospice contract, with a median of 3 residents enrolled in the last 3 months. Nursing home administrators were less likely than hospice administrators to believe that hospice improves quality of care for pain, emotional and spiritual needs, and bereavement support. Nursing home administrators were more likely to agree that, "Nursing homes provide good care without using hospice for dying residents and their families," (24% versus 1%, p < 0.001). Among nursing home administrators with a hospice contract (n = 180), those who agreed that hospice improves quality of care had higher rates of hospice use in their facilities. Conclusions: Nursing home administrators' attitudes toward hospice may influence its availability for nursing home residents.