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Government expenditures at the end of life for short- and long-stay nursing home residents: differences by hospice enrollment status
Miller SC, Intrator O, Gozalo P, Roy J, Barber J, Mor V.. Journal of the American Geriatrics Society, 2004-08-01
Topic: Risk, prevention and care in population studies
Objectives To examine end-of-life government expenditures for short- and long-stay Medicare- and Medicaid-eligible (dual-eligible) nursing home (NH) hospice and nonhospice residents. Design A retrospective cohort study. Setting Six hundred fifty-seven Florida NHs. Participants Dual-eligible NH residents who died in Florida NHs between July and December 1999 (N=5,774). Measurements Nursing home stays of 90 days or less were considered short stays (n=1,739), and those over 90 days were long stays (n=4,035). Three diagnosis groups were studied: cancer without Alzheimer's disease or dementia, Alzheimer's disease or dementia, and other diagnoses. Eligibility and expenditure claims data for 1998 and 1999 were merged with vital statistics and NH resident assessment data to determine diagnoses, location of death, hospice enrollment, eligibility, and expenditures. Results Twenty percent of short-stay (n=350) and 26% of long-stay (n=958) NH decedents elected hospice; of these, 73% of short-stay and 58% of long-stay NH residents had hospice stays of 30 days or less. Overall, mean government expenditures in the last month of life were significantly less for hospice than nonhospice residents (7,365 dollars; 95% confidence interval (CI)=7,144-7586 dollars vs 8,134 dollars; 95% CI=7,896-8,372 dollars), but 1-month expenditures were only significantly lower for hospice residents with short NH stays, not for those with long NH stays. Conclusion Overall, hospice care in NHs does not appear to increase government expenditures. Because significantly lower expenditures are observed for short-stay NH hospice residents, policy restricting access to Medicare hospice for Medicare skilled nursing facility residents may represent a missed opportunity for savings.
Key findings
- Results Twenty percent of short-stay (n=350) and 26% of long-stay (n=958) NH decedents elected hospice; of these, 73% of short-stay and 58% of long-stay NH residents had hospice stays of 30 days or less.
- Overall, mean government expenditures in the last month of life were significantly less for hospice than nonhospice residents (7,365 dollars; 95% confidence interval (CI)=7,144-7586 dollars vs 8,134 dollars; 95% CI=7,896-8,372 dollars), but 1-month expenditures were only significantly lower for hospice residents with short NH stays, not for those with long NH stays.
- Conclusion Overall, hospice care in NHs does not appear to increase government expenditures.
- Because significantly lower expenditures are observed for short-stay NH hospice residents, policy restricting access to Medicare hospice for Medicare skilled nursing facility residents may represent a missed opportunity for savings.
Study details
- Study designcohort study
- Participants5,774
- Evidence strengthModerate
How this study scored 62/100
Published in a peer-reviewed journal, and it is a cohort study following people over time. Scored zero for effect reported and randomised / blinded because the record does not state it. We have no data on journal's citation record, times cited, citations per year, impact for its field and year, cited by studies here, still being cited, senior author's track record, institution's track record and multi-centre collaboration, so those were left out: it earned 36 of the 58 points we could judge it on, which is 62 out of 100.
| Component | Points | Why |
|---|---|---|
| Journal tier | 7 / 10 | Tier 3 — peer-reviewed journal (Journal of the American Geriatrics Society) |
| Journal's citation record | — / 4 | No journal record from OpenAlex — left out of this score |
| Study design | 7 / 12 | A cohort study following people over time |
| Strength of evidence | 3 / 5 | Rated “moderate” in our summary |
| Peer-review validation | 10 / 10 | Peer-reviewed. Published as an article in a named peer-reviewed journal. |
| How recent | 1 / 5 | 2004 — older than 20 years, still counted |
| Sample size | 3 / 4 | 5,774 participants |
| Effect reported | 0 / 3 | No effect size reported — scores zero (not stated in the record — scored 0) |
| Studied in people | 3 / 3 | Studied in people (participant count stated) |
| Randomised / blinded | 0 / 2 | No randomisation or blinding stated — scores zero (not stated in the record — scored 0) |
| Times cited | — / 7 | No citation count (not found in OpenAlex) — left out of this score |
| Citations per year | — / 5 | No citation count or no year — left out of this score |
| Impact for its field and year | — / 6 | No field-weighted citation impact (OpenAlex has none yet) — left out of this score |
| Cited by studies here | — / 6 | Not yet checked against this library's citation graph — left out of this score |
| Still being cited | — / 4 | No yearly citation counts — left out of this score |
| Senior author's track record | — / 4 | Senior author's record not available — left out of this score |
| Institution's track record | — / 3 | No institution listed in OpenAlex — left out of this score |
| Multi-centre collaboration | — / 3 | Institutions not listed — left out of this score |
| Indexed in PubMed | 2 / 2 | Indexed in PubMed (PMID 15271115) |
| Free to read | 0 / 2 | Behind a paywall — scores zero |
| Points | 36 / 58 | Scored on 11 of 20 parts. We have no data for the rest, so they are left out: 36 of the 58 points we could judge it on is 62 out of 100. |
| Total | 62 / 100 | — |
What each of these 20 components measures, and what this score is not →
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APA 7th
Miller, S. C., Intrator, O., Gozalo, P., Roy, J., Barber, J., & Mor, V. (2004). Government expenditures at the end of life for short- and long-stay nursing home residents: differences by hospice enrollment status. Journal of the American Geriatrics Society. https://doi.org/10.1111/j.1532-5415.2004.52357.x
Vancouver
Miller SC, Intrator O, Gozalo P, Roy J, Barber J, Mor V. Government expenditures at the end of life for short- and long-stay nursing home residents: differences by hospice enrollment status. Journal of the American Geriatrics Society. 2004. doi:10.1111/j.1532-5415.2004.52357.x. PMID: 15271115.
BibTeX
@article{miller2004-15271115,
author = {Miller, S. C. and Intrator, O. and Gozalo, P. and Roy, J. and Barber, J. and Mor, V.},
title = {{Government expenditures at the end of life for short- and long-stay nursing home residents: differences by hospice enrollment status}},
journal = {Journal of the American Geriatrics Society},
year = {2004},
doi = {10.1111/j.1532-5415.2004.52357.x},
pmid = {15271115},
url = {https://doi.org/10.1111/j.1532-5415.2004.52357.x}
}