Nursing Home Participation in End-of-Life Programs
Author: Helaine Resnick, Gregory Foster and Susan Hickman
Publication Date: April 2009
This report defines the extent to which U.S. nursing homes (NH) participated in end-of-life programs using a nationally representative, cross-sectional sample of U.S. NHs. Data on EoL programs including Five Wishes, Last Acts, and Physician Orders for Life-Sustaining Treatment (POLST) were collected. In 2004, 17.2% of NH reported participating in 1 or more of these programs, with the largest proportion participating in POLST (13.3%) and smaller proportions in Five Wishes (5.6%) and Last Acts (4.2%). Nursing homes were more likely to participate in EoL programs if they also offered specialty programs and staff training for hospice, end-of-life, pain management, and dementia services. In 2004, fewer than 1 in 5 U.S. NH participated in an EoL program. However, facilities that had EoL programs were more likely to have programs and staff training for services related to EoL care, a finding that suggests a clustering of these programs, services, and training. Provision of appropriate staff training may be a key to expanding EoL program participation in skilled nursing.

Advance Directives in Nursing Home Residents 65 Years and Older
Author: Helaine Resnick, Jeremiah Shuur, Janice Heineman, Robyn Stone and Joel Weissman
Publication Date: October 2008
In 1996, 53% of U.S. nursing home residents had advance directives. This report defines documentation of advance directives in a nationally representative survey of U.S. nursing home residents aged >65 years in 2004, as well as advance directive use in relation to demographic factors and receipt of specialty services including hospice/palliative care. In 2004, advance directives were documented in 69.9% of U.S. nursing home residents aged >65 years and in 93.6% of residents receiving hospice/palliative care. Documentation of advance directives increased substantially between 1996 and 2004 and was nearly universal among residents receiving hospice/palliative care services. However, 3 of every 10 U.S. nursing home residents still did not have documentation of advance care plans in 2004.

Advance Directies in Home Health and Hospice Agencies: United States, 2007
Author: Resnick, HE, Hickman, SE and Foster, GL
Publication Date: March 2011
This report provides nationally representative data on policies, storage, and implementation of advance directives (AD) in home health and hospice (HHH) agencies in the United States using the National Home and Hospice Care Survey. Federally mandated ADs policies were followed in >93% of all agencies. Nearly all agencies stored ADs in a file at the agency, but only half stored them at the patient's residence. Nearly all agencies informed staff about the AD, but only 77% and 72% of home health agencies informed the attending physician and next-of-kin, respectively. Home health and hospice agencies are nearly universally compliant with ADs policies that are required in order to receive Medicare and Medicaid payments, but have much lower rates of adoption of ADs policies beyond federally mandated minimums.

Documentation of Advance Directives among Home Health and Hospice Patients: United States, 2007
Author: Resnick, HE, Hickman, S and Foster, GL
Publication Date: May 2011
This report provides nationally representative data on documentation of advance directives (AD) among home health (HH) and hospice patients. Advance directives were recorded for 29% of HH patients and 90% of hospice discharges. Among HH patients, increasing age and use of assistive devices were associated with greater odds of having an AD, while being Hispanic or black (relative to white) and enrolled in Medicaid decreased the odds of having ADs. Among hospice discharges, being enrolled in Medicare and having 4 or 5 activities of daily living (ADL) limitations were associated with higher odds of ADs while depression, use of emergency services, and being black (relative to White) were associated with lower odds. Even after adjustment for potentially confounding factors, racial differences persist in AD documentation in both care settings.