By Lisa Rapaport
(Reuters Health) – Hospice care may start closer to the end of life for residents of assisted living facilities than for people receiving care at home, a recent study finds.
Assisted living facility residents may moreover be less likely to receive opiate painkillers to ease discomfort in their final days, & less likely to die in an inpatient hospice unit.
p> â€œThese findings point out the importance of thinking carefully approximately the advantages & disadvantages of care settings,â€ lead study author Dr. David Casarett, director of palliative care for Penn Medicine, said by email.
Each year, an estimated 1.6 million Americans receive hospice care, which focuses on comfort & quality of life rather than on curing disease, Casarett & colleagues note in the Journal of the American Geriatrics Society.
While roughly two thirds of people â€œin hospiceâ€ receive care at home, a significant minority â€“ 7 percent â€“ live in residential facilities such as assisted living settings, according to the researchers. By 2050, 27 million people will be 65 & older in the U.S., & many of them will be housed in assisted living.
To explore the differences in hospice care for patients living at home versus people in assisted living, the researchers reviewed electronic medical records for 12 nonprofit hospice programs in New Mexico, California, Pennsylvania, Wisconsin, Michigan, Ohio, Florida, Texas, Kentucky, Kansas & Missouri.
At hospice enrollment, between 2008 & 2012, 78,130 of the patients in the study lived at home & 7,451 were in assisted living.
Assisted living patients were typically older & more likely to be female & have dementia, disability or at least one previous stroke. People receiving home hospice care were more likely to have cancer.
Hospice stays tended to be briefer in assisted living, lasting no more than 24 days for half the patients in that setting, compared to at least 29 days for half of the home hospice patients.
Pain was usual regardless of where patients received care. But assisted living residents were roughly half as likely as people at home to receive powerful opiate painkillers.
Men & people with cancer were more likely to receive opiates, while white & older patients were less likely to obtain these medicines.
Assisted living residents were moreover approximately half as likely as home hospice patients to die in a hospital setting, the researchers note.
One limitation of the study is that it didnâ€™t include individual patients' pain levels or preferences approximately where they wanted to die, the authors acknowledge.
Itâ€™s surprising that access to opiates varied by care setting, yet encouraging that assisted living facility residents with hospice care received to stay â€œhomeâ€ to die, said Dr. Laura Hanson, co-director of the palliative care program at the University of North Carolina School of Medicine in Chapel Hill.
â€œThe study cannot tell us if hospice improved other aspects of pain management â€“ other medications, music or massage therapy, for example,â€ Hanson, who wasnâ€™t involved in the study, said by email.
Families & patients weighing options for end of life care should work closely with doctors & nurses to understand the course of their illness & what usual medical situations are likely to arise, said Marlene McHugh, a palliative care researcher at Columbia University School of Nursing.
Patients should consider: â€œWill I require a feeding tube, oxygen, dialysis?â€ McHugh, who wasnâ€™t involved in the study, said by email. â€œAppoint someone to be your voice, to make decisions on your behalf.â€
Sometimes hospice begins too late to provide enough time for optimal support & pain management, said Debra Dobbs, a researcher in aging at the University of South Florida in Tampa who wasnâ€™t involved in the study.
End of life care decisions need to be documented in the form of advanced directives, moreover known as living wills, as well as do-not-resuscitate (DNR) orders barring the use of interventions such as ventilators, respirators or life support, Dobbs said by email.
The most significant step to ensure patients receive hospice care thatâ€™s in line with their personal beliefs & preferences, according to Hanson: â€œCommunicate, communicate, communicate.â€
SOURCE: http://bit.ly/1ejEQYG Journal of the American Geriatrics Society, online June 19, 2015.
Hospice careassisted living facilitiespalliative care