Site of death in the hospital versus nursing home of medicare skilled nursing facility residents admitted under medicare's part a benefit

OBJECTIVES: To determine factors that predict site of death (hospital vs nursing home (NH)), related costs, and geographic variation in site of death of NH residents admitted under the Medicare Part A Benefit. DESIGN: Retrospective cohort study. SETTING: NHs located in the United States (N = 13,146). PARTICIPANTS: All persons admitted to skilled nursing facilities (SNFs) in 2001 who died in a SNF (n = 101,307) or hospital (n = 51,187). MEASUREMENTS: Patient, facility, and geographic characteristics associated with death in a hospital and receipt of Medicare payment. RESULTS: Absence of a do-not-resuscitate order, non-Caucasian ethnicity, greater functional independence, and higher cognitive status correlated with hospital as the site of death. Rural, hospital-based, and government-owned facilities had the lowest in-hospital death rates. Site of death varied widely from state to state. Of those who died in a hospital, 24.2% (12,410) died within 24 hours of transfer. The average daily combined stay Medicare payment for those who died in the hospital was $969, versus $300 for those who died in a NH. CONCLUSION: Patient and facility characteristics predict site of death of Medicare NH patients, but in-hospital death rather than NH death varies geographically and is associated with higher daily Medicare payment.