A Secondary Analysis of the Intensity of Hospice Visits Among Medicare Decedents in the Last Seven Days of Life by Place of Residence.

BACKGROUND: In 2016, Medicare finalized the Service Intensity Add-on (SIA) payment policy to increase the intensity of hospice registered nurse (RN) or social worker (SW) visits in the last 7 days of life. The research objective was to compare the intensity of hospice RN or SW visits in the last 7 days of life among older decedents who received a hospice visit, while residing in a traditional home, an assisted living facility, or long-term nursing home. METHODS: A retrospective analysis using 2016-2018 Medicare data of decedents 65 years or older (n= 2 067 863) related to the Medicare SIA payment policy. Intensity was defined as the number and duration of hospice RN or SW visits in the last 7 days of life using Medicare claims code G0299 and G0155. RESULTS: Regression results suggest that decedents who received a SIA related visit while residing in an assisted living facility, had on average a slightly longer duration of hospice RN visits in the last 7 days of life, compared to decedents residing in a traditional home, after controlling for demographics and other factors (P<.0001). The duration of hospice RN visits remained unchanged among decedents who received a SIA visit in 2017 or 2018, when compared to 2016 (P <.0001). Overall the average number of hospice SW visits did not differ by place of residence among decedents who received a SIA visit. CONCLUSIONS: Among decedents who received a SIA related visit, the duration of hospice RN visits were slightly different by place of residence.

Academic-Service Partnerships: Increasing the Advanced Nurse Workforce.

BACKGROUND: Clinical education placement for advanced practice registered nurse (APRN) students is challenging for most graduate schools of nursing. This study describes the experiences of hospitals that formed academic-service partnerships to facilitate clinical education placement for APRN students. METHOD: Hospital staff, schools of nursing administration and clinical faculty staff, clinical preceptors, and APRN students participated in the focus group and interview sessions during the evaluation of the Graduate Nurse Education demonstration project. RESULTS: Content analysis resulted in seven themes: APRN Student Enrollment, Clinical Placements/Process, Clinical Education Sites, Clinical Preceptors, Communication and Collaboration, Sustainability, and Funding Process. CONCLUSION: Future partnerships between hospitals, schools of nursing, and clinical education sites should consider collaborating in multiple regions to increase enrollment and clinical education placement opportunities for APRN students. [J Nurs Educ. 2021;60(4):190-195.].

Characteristics of Decedents in Home Settings Using Medicare Place of Hospice Service Codes.

Very little is known about the characteristics of the Medicare beneficiaries receiving hospice at home, defined using the Medicare Healthcare Common Procedure Coding System codes, as a traditional home, an assisted living facility, or a nursing home. A secondary analysis of 2015 Medicare data using regression to describe the characteristics of decedents (n = 675 782) in hospice residing in a traditional home, an assisted living facility, and a nursing home was completed. Results suggest that the proportion of Medicare decedents in hospice with more than 180 lifetime days in hospice was highest among those who resided in an assisted living facility (25.03%) compared with those who resided in a nursing home (18.87%) or in a traditional home (13.04%). Regression findings suggest that, compared with decedents in hospice without dementia who resided in a traditional home, decedents in hospice with a primary diagnosis of dementia were more likely to reside in an assisted living facility (adjusted odds ratio, 2.29; P < .0001) when controlling for other factors. In summary, decedents in hospice who resided in a traditional home have different characteristics than decedents who resided in an assisted living facility or a nursing home. Interdisciplinary providers should consider these differences when managing hospice interventions.

Do Community and Caregiver Factors Influence Hospice Use at the End of Life Among Older Adults With Alzheimer Disease?

Hospice is an underused service among people with Alzheimer disease. This study used the Hospice Use Model to examine community, care recipient, and caregiver characteristics associated with hospice use before death among 145 community-dwelling care recipients with Alzheimer disease and their caregivers. Secondary analysis using logistic regression modeling indicated that older age, male gender, black race, and better functional health of care recipients with Alzheimer disease were associated with a decreased likelihood of using hospice (model χ25 = 23.5, P = .0003). Moreover, care recipients recruited from an Alzheimer clinic were more likely to use hospice than those recruited from adult day-care centers. Caregiver factors were not independent predictors of hospice use. However, there was a significant interaction between hours of care provided each week and recruitment site. Among care recipients from the Alzheimer clinic, the probability of hospice use increased as caregiving intensity increased. This relationship was reversed in care recipients from day-care centers. Results suggest that adult day-care centers need to partner with hospice programs in the community. In conclusion, care recipient and community service factors influence hospice use in individuals with Alzheimer disease.

Use of healthcare access models to inform the patient protection and affordable care act.

Health policy findings on access to care provide more substantive information if linked to a theory that provides meaningful structure and standard definitions. Three theories of access are reviewed here because they have been used to inform health policy: Penchansky's Model, The Institute of Medicine (IOM) Model of Access Monitoring, and The Behavioral Model of Health Services Use. Penchansky's model is useful when subjective experiences with health care access are needed to inform policy makers. The IOM model is used for monitoring quality of health care services provided. The Behavioral Model identifies explanatory/predictive factors associated with utilization of services. Each model uniquely evaluates different health policies. Given the passage of the Patient Protection and Affordable Care Act (PPACA) of 2010, researchers and policy makers must agree on the model that best monitors and evaluates these new policy initiatives.