aide helping resident

Older adult use of hospice services at the end of life is higher in community-based residential settings, such as assisted living and retirement communities, than in nursing homes and traditional homes, according to a newly published study.

“Trends In Residential Setting And Hospice Use At The End Of Life For Medicare Decedents,” published by Health Affairs, is the first national study of deceased Medicare beneficiaries categorized by residential setting, according to the authors. The study used data form the Medicare Current Beneficiary Survey 2002-2017 and tracked 8,394 older adults representative of the 28.4 million Medicare beneficiaries who died during the study period.

According to the study, 9.8% of Medicare beneficiaries spent the end of their lives in community-based residential settings, including assisted living facilities (30.4%), retirement communities (23.2%), continuing care facilities (16.4%) and senior citizen housing (12.3%).

Efforts by state Medicaid programs to fund long-term services and supports in home- and community-based settings, rather than for nursing home care, is “a key driver of the growth in community-based residential care,” the authors wrote. State and federal policies also encouraged the use of nursing home alternatives, including assisted living communities, board and care facilities and adult foster care, they said.

“Where people live as they age has implications for health care delivery, costs and policy,” the authors wrote.

As more people live and die in residential care communities, the need for hospice there increases, the authors said. Compared with beneficiaries living in private residences, older adults in residential community settings at the end of life were more likely to have dementia, less likely to have cancer, and more likely to receive help with three or more activities of daily living.

Hospice use in these settings at the end of life was significantly higher (51.2%) than for those in private residences (37.3%) and in nursing homes (43.9%). The highest hospice use among residential care community types was in assisted living communities (61.1%), and the lowest was in senior citizen housing (32.7%).

“Our findings of high rates of hospice penetration in community-based residential settings is not surprising, given the prevalence of people with serious illness and functional impairment, and the often limited medical and nursing support in these settings,” the report stated.

Future work to characterize the specific services offered in these settings will provide a better understanding of how hospice can be used to improve end-of-life care in communities, the authors noted.