Background and objectives: Hospice improves the quality of end of life care in nursing homes
but serves less than 10% of dying residents. For residents to elect hospice, nursing homes
must first contract for these services. We surveyed nursing home and hospice administrators
to describe facilitators and barriers to hospice in nursing homes, and to test whether nursing
home administrators' attitudes correlate with hospice use.
Methods: In a mailed survey, all nursing home and hospice administrators in North Carolina
responded to items on hospice's effect on quality of care, and on facilitators and barriers
to its use in nursing homes. Among nursing home administrators, bivariate analyses were
used to test associations of attitudes with use of hospice.
Results: After 2 mailings, 241 (62%) nursing home administrators and 74 (85%) hospice administrators
responded. Eighty-three percent of nursing homes had a hospice contract, with
a median of 3 residents enrolled in the last 3 months. Nursing home administrators were less
likely than hospice administrators to believe that hospice improves quality of care for pain,
emotional and spiritual needs, and bereavement support. Nursing home administrators were
more likely to agree that, "Nursing homes provide good care without using hospice for dying
residents and their families," (24% versus 1%, p < 0.001). Among nursing home administrators
with a hospice contract (n = 180), those who agreed that hospice improves quality of
care had higher rates of hospice use in their facilities.
Conclusions: Nursing home administrators' attitudes toward hospice may influence its availability
for nursing home residents.
