Increasing hospice services can reduce hospital admissions among all residents of a nursing home, including those not enrolled in hospice, according to findings recently published in the Journal of the American Medical Directors Association (JAMDA).

For every 10% increase in “hospice penetration” at a given facility, the risk of hospitalization decreases 5.1% for non-hospice residents and 4.8% for hospice-enrolled residents, the investigators determined.

The study authors focused on long-stay nursing home residents who died between 2005 and 2007, drawing on data from sources such as Medicare inpatient and hospice claims and the Minimum Data Set 2.0. They calculated that in the nearly 14,000 included facilities, about 38% of non-hospice residents and 23% of hospice residents were hospitalized in the last 30 days of life.

Study Objectives

Hospice enrollment is known to reduce risk of hospitalizations for nursing home residents who use it. We examined whether residing in facilities with a higher hospice penetration:

1) reduces hospitalization risk for nonhospice residents; and

2) decreases hospice-enrolled residents’ hospitalization risk relative to hospice-enrolled residents in facilities with a lower hospice penetration.


Medicare Beneficiary File, Inpatient and Hospice Claims, Minimum Data Set Version 2.0, Provider of Services File, and Area Resource File. Retrospective analysis of long-stay nursing home residents who died during 2005-2007. Overall, 505,851 nonhospice (67.66%) and 241,790 hospice-enrolled (32.34%) residents in 14,030 facilities nationwide were included. We fit models predicting the probability of hospitalization conditional on hospice penetration and resident and facility characteristics. We used instrumental variable method to address the potential endogeneity between hospice penetration and hospitalization. Distance between each nursing home and the closest hospice was the instrumental variable.


In the last 30 days of life, 37.63% of non-hospice and 23.18% of hospice residents were hospitalized. Every 10% increase in hospice penetration leads to a reduction in hospitalization risk of 5.1% for nonhospice residents and 4.8% for hospice-enrolled residents.


Higher facility-level hospice penetration reduces hospitalization risk for both non-hospice and hospice-enrolled residents. The findings shed light on nursing home end-of-life care delivery, collaboration among providers, and cost benefit analysis of hospice care.

The findings “shed light” on the benefits of collaboration between nursing homes and hospice providers, the authors wrote. They were affiliated with a variety of institutions, including RTI International and the University of California, Irvine.

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