UCSF

This research examined trends in California Hospices during the period 2000-2005. The main aims were to describe trends in hospice characteristics, and quality, utilization and cost in California between 2000 and 2005 and to test the hypotheses that for-profit and chain hospices would be associated with longer lengths of stay, increased numbers of patients with non-cancer diagnoses, and decreased RN visits per patient. Methods: Utilization and financial data from the California Office of Statewide Health Planning and Development for hospices filed annually from 2000-2005 and data from public sources. Descriptive statistics identified trends for approximately 200 hospices. Regression models examined quality, utilization and cost outcomes for 2005. Results: The number of for-profit and chain hospices increased by 36% and 20% respectively. Sixty-six % of California's rural counties have no hospices. The percentage of female patients increased ½% per year, hospice patients over 81 years old increased by 2% per year. Longer lengths of stay (LOS) and greater percentages of patients with non-cancer diagnoses were associated with for-profit and chain hospices. Percent of Hispanic patients predicted decreased LOS and decreased visits by RNs. An Increased percentage of Hispanics in the county predicted decreased deficiencies by licensing agencies. For-profit hospices spent less on RNs care and chain hospices had more complaints. Increased county per capita income predicted increased deficiencies identified by the state licensing agency. Discussion: By 2020, 80% of hospice patients will be over 81 years old and 66% will be female. Chain hospices are associated with lower quality of care and for-profit hospices provided less professional care. These findings suggest the importance of the need for closer monitoring of quality and access to care. The recent CMS change allowing a longer 8 years rather than six years between required certification inspections for hospices this should be of concern to those concerned about quality of care and changes in the hospice model of care.