Objectives: To examine the attitudes of residential care/assisted living (RC/AL) and nursing
home (NH) administrators toward hospice and to assess facility and administrator characteristics
related to those attitudes.
Design: Two exploratory factor analyses of the Hospice Attitudes Questionnaire using principal
factors with a promax (oblique) rotation were conducted. One was in a sample of 390
RC/AL and NH administrators from four states (Florida, Maryland, North Carolina, and New
Jersey) and the other included NHs from this and a second sample (n = 244). Association between
facility and administrator characteristics and administrator attitudes towards hospice
were examined among the 146 RC/AL administrators.
Results: Exploratory factor analysis in the full sample resulted in the 12-item Long-Term
Care Hospice Attitudes Scale (LTC-HAS) with four component subscales: (1) emotional and
spiritual support (three items, α = 0.83); (2) quality of care (four items, α = 0.78); (3) rapidity
of death (three items, α = 0.66) and (4) end-of-life care coordination (two items, α = 0.73). The
overall alpha for the 12-item scale was 0.81. When exploratory factor analysis was conducted
on the NH data only, a three-item subscale related to financing and billing (α = 0.66) also
emerged. Four facility and three administrator characteristics that were significantly related
to hospice attitudes included state, facility type, facility age, affiliation with another level of
care; and age, race, and nurse training.
Conclusion: Findings from this paper provide insight about RC/AL facility and NH administrators'
attitudes towards Hospice using scale data, an area with limited research. They
indicate positive attitudes toward Hospice care coordination, and that Hospice should supplement,
as opposed to replace, the care provided by facilities. Findings also suggest areas
where targeted outreach and further study may be recommended.
