BACKGROUND/RATIONALE:
Hospice utilization in Veterans Affairs (VA) nursing homes, called Community Living Centers (CLCs), is inconsistent. The annual mortality rate among the CLC population is 39%. As the number of veterans with end-of-life (EOL) care needs in CLCs increases, it is imperative to understand end-of-life care practices in CLCs and identify CLC residents with limited life expectancy so that veterans can receive hospice services if prognosis is six months or less and when goals of care are focused on comfort rather than cure.

OBJECTIVE(S):
1) Describe characteristics of veterans living in a CLC prior to death, 2) determine factors that predict site of death (hospital vs. CLC) among veterans living in a CLC, and 3) develop a tool to identify CLC residents at risk for death.

METHODS:
The Vital Statistics File was used to identify veterans with a date of death in FY2005. Minimum Data Set (MDS) data were extracted for all decedents and site of death was identified using the Extended Care Main File. Two group comparisons were performed followed by multivariate regression analysis to determine factors predictive of hospital as a site of death. The Hospice Eligibility Prediction (HELP) tool was developed using MDS data to provide a reliable method for identifying the CLC population eligible for hospice care (<6month life expectancy). Site visits were performed at five CLCs to gain an in-depth understanding of how hospice programs in CLCs identify veterans at risk of death and provide end-of-life care.

FINDINGS/RESULTS:
Not yet available.

IMPACT:
Hospice use among CLC decedents exceeds hospice usage reported in community-based nursing homes. Prevalence of severe pain is high and many lack documented care goals. Absence of documented care goals is associated with a higher likelihood of hospital death and repeated hospitalizations but hospice is associated with improved EOL care practices. These results highlight areas for improvement in EOL care of veterans in CLCs. Improved identification of hospice-eligible CLC residents may increase appropriate hospice utilization in CLCs as has been observed in community-based nursing homes.

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External Links for this Project

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PUBLICATIONS:

None at this time.

DRA: Health Systems Science, Aging, Older Veterans' Health and Care
DRE: Prevention
Keywords: End-of-life
MeSH Terms: none