End-of-life care in nursing homes: 2004 National Nursing Home Survey.

OBJECTIVES This report presents information on nursing home residents receiving end-of-life (EOL) care in nursing homes. Residents receiving EOL care are compared with those not receiving EOL care on demographics, functional and cognitive status, reported pain, medications, and diagnoses. Residents receiving EOL care are further categorized by whether they started EOL care on or prior to admission to the nursing home or after admission to the nursing home. These two groups receiving EOL care are compared with each other on demographics, functional and cognitive status, medications, diagnoses, length of time receiving EOL care, and treatments received. METHODS Data are from the resident component of the 2004 National Nursing Home Survey (NNHS). The 2004 NNHS is a nationally representative, cross-sectional probability sample survey of all current residents in nursing homes in the United States with three or more beds and either certified by Medicare or Medicaid or licensed by the state. All information is derived from interviews with nursing home staff. RESULTS Nursing home residents receiving EOL care were older, more functionally and cognitively impaired, and more likely to have reported pain in the previous 7 days compared with nursing home residents not receiving EOL care. They were also more likely to have at least one advance directive. Three-fourths of residents who received EOL care in the nursing home started EOL care after admission to the nursing home. Differences in age, functional impairment, and cognitive impairment were observed among residents receiving EOL care depending on when they started EOL care. However, no differences in services and treatments received were observed depending on whether EOL care started on or prior to admission or after admission to the nursing home. The mean length of time on EOL care was approximately 5 months and did not differ by whether the care started on or prior to admission or after admission to the nursing home.