Do Hospices Specializing in Long-Term Care Settings Provide Better Care to Beneficiaries with Alzheimer's and Related Dementia?

PROJECT SUMMARY Hospice programs have been historically less experienced in caring for beneficiaries with Alzheimer’s and Related Dementia (ADRD), although ADRD represents one of the fastest growing primary diagnoses among hospice beneficiaries. A majority of hospice beneficiaries in long-term-care (LTC) settings have ADRD,and it is

possible for certain hospice programs (i.e. those with higher volumes of beneficiaries with ADRDand/or in LTC settings) to be better at caring for the challenging end-of-life care needs of ADRD beneficiaries. Such specialization could be achieved through hospice programs’ greater clinical experience in dementia care

and/or collaboration with LTC staff. However, it requires more research to understand the quality implications when a hospice program have a higher volume of LTC beneficiaries (i.e. an LTC hospice). This is because LTC hospices may target LTC beneficiaries with financial incentives, given that LTC beneficiaries have overall

longer lengths of hospice stay, who are more profitable to the hospice program under the Medicare Hospice Benefit payment structure. A lack of knowledge on this issue prevents the identification of best hospice care practices for ADRD beneficiaries and an effective modification to the Medicare Hospice Benefit. Building on our

ongoing research and in response to PAS-19-391, our proposed study has two aims: 1) Describe individual-, nursing home/assisted living-, hospice-, and neighborhood-level characteristics associated with receiving care from LTC hospices, overall trend and by care settings (i.e. nursing home, assisted living, community); 2)

Compare the quality outcome between beneficiaries with ADRD who receive care from LTC hospices with a those receiving care from non-LTC hospices, using difference-in-difference cross-temporal matching. This study is innovative in that we include assisted living in defining LTC hospices, given that assisted living is

an increasingly common site of hospice care for beneficiaries with ADRD. We will examine whether/how quality outcomes differ by hospice specialization and care settings, given that prior research shows care setting to be an important determinant for hospice quality outcome. The application of difference-in-difference cross-

temporal matching addresses several important selection issues (i.e. personal preference for hospice by specialization type, selections between nursing home/assisted living and hospice) in examining the quality performance of LTC hospices. The use of national claims data will enhance our knowledge at the national level

about the quality of LTC hospices, because prior research relies mostly on survey data. By the end of this project, we will determine whether beneficiaries with ADRD, who receive care from LTC hospices in different care settings, experience better outcomes. The expected outcome of this project is to provide empirical

evidence on how hospice programs’ specialization impacts the quality of care among ADRD beneficiaries. These contributions represent the first step of a larger research project that further examines the impact of recent policy changes and market shifts on the quality of hospice care delivered to ADRD beneficiaries.