Hospice Care in Assisted Living Facilities Must Meet Residents’ Unique Needs

The use of hospice care has been on a continuous rise for the past 10 years, with 1.5 to 1.6 million people using hospice every year. The majority of this use is by older adults. Although most people in hospice are provided care at home (66%), a significant minority (7%) reside in care facilities such as assisted living settings. Furthermore, by 2015, 27 million people will be 65 years of age and older, and many of them will be residents of assisted living facilities.

Past studies have shown that assisted living facility staff does not have adequate knowledge about end-of-life care. Due to it not being necessary for caregivers to be certified nursing assistants, some may not be prepared enough to respond appropriately to unexpected events, such as a pain crisis or sudden shortness of breath. Moreover, the staffing levels in assisted living facilities may not give caregivers the opportunity to devote the necessary time to the intense and changing care needs of a dying resident. Lastly, conflicting schedules of assisted living facility administrators, registered nurses, and hospice registered nurses may further complicate the coordination of hospice care.

Even less is known on whether differences in demographics or diagnostic characteristics exists among hospice residents in assisted living facilities compared with those of individuals receiving hospice care in their homes. Furthermore, it is not known whether assisted living facility residents experience a higher volume of symptoms such as pain. Finally, not much is known whether outcomes such as time to death and site of death are different between those living at home and assisted living facility residents. If assisted living facility residents do possess unique characteristics, needs, or trajectories of care, then there needs to be a way to customize hospice programs to meet their needs. Thus, researchers performed a study that compared the characteristics and outcomes of patients admitted to hospice at home with those in assisted living facilities to elucidate how hospice care could be better adjusted to meet the needs of this growing cohort.

After examining the measurements of hospice duration of stay, use of opioids for pain, and site of death, the study results showed that assisted living residents were more likely than those living at home to have a diagnosis of dementia and enroll in hospice closer to end of life. Assisted living residents were not as likely to receive opioids for pain and not as likely to perish in an inpatient hospice unit. The study concluded that there are various differences between residents of assisted living receiving hospice care and those living at home receiving hospice care.

The results show that hospices and assisted living facilities that partner to provide care must be vigilant in monitoring their residents’ conditions to ensure that assisted living facility residents are getting the same quality of care that hospices provide for individuals living at home.