Hospice Use and Public Expenditures at the End of Life in Assisted Living Residents in a Florida Medicaid Waiver Program

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Abstract

OBJECTIVES:

To examine the association between hospice use and public expenditures in a sample of dually eligible assisted living (AL) residents at the end of life.

DESIGN:

A retrospective cohort study.

SETTING:

Florida AL facilities.

PARTICIPANTS:

Newly enrolled dually eligible older AL residents under Florida's Medicaid Assisted Living for the Elderly waiver program who died between January 2003 and December 2004 (N = 382).

MEASUREMENTS:

Individual sociodemographic characteristics were obtained from Florida's Medicaid comprehensive assessment data. Medicaid eligibility status, enrollment in the AL waiver programs, International Classification of Diseases, Ninth Revision, Clinical Modification, codes and Medicaid claims data were obtained from Florida's Medicaid payment agency. Individual characteristics and Medicare and Medicaid claims data were merged with vital statistics to determine diagnoses, date of death, hospice enrollment, and public expenditures.

RESULTS:

The mean age of the study sample was 84.8 (range 65–102); 71.5% were female, and 63.4% were white. During the average 9.6 months of follow-up, 35.6% of the sample enrolled in hospice, and the average hospice length of stay was 47.9 d; 73.3% of the sample had been admitted to a hospital, and 38.0% had been admitted to a nursing home. The generalized linear model showed that hospice use was not significantly associated with lower public expenditures (average marginal effect = −$1,127, 95% confidence interval = −$8,377, $6,122).

CONCLUSION:

Hospice use at the end of life may not be associated with lower public expenditures in older dually eligible AL residents. Future research should examine the association between hospice enrollment and the quality of end-of-life care.

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