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Published Online: 7 August 2009

Is a Home-Care Network Necessary To Access the Medicare Hospice Benefit?

Publication: Journal of Palliative Medicine
Volume 12, Issue Number 8

Abstract

Objective: To test whether the presence of an informal or formal care network in the home leads to different hospice utilization patterns near death. To examine how the informal care relationship affects hospice use patterns.
Data sources: Medicare Current Beneficiary Survey (MCBS), 1997–2001.
Study design: Using logistic regression and ordinary least squares, we examine the association between a person's in-home network of care and the use of Medicare hospice services in the last year of life. We also examine whether the care-dyad relationship is associated with different hospice use patterns.
Data extraction: All individuals in the MCBS who lived at home at the time of the interview and who died between 1998 and 2001, 1404 persons.
Principal findings: People receiving formal home care had a much higher chance of enrolling in hospice prior to death. Informal care did not influence the likelihood of hospice but was associated with longer use among hospice users. Daughter caregivers increased the likelihood and duration of hospice use whereas sons significantly decreased the likelihood.
Conclusions: Because formal care is associated with increased use of hospice, future work should examine whether patients without an in-home network faced access barriers. Caregiver relationships had large effects on length of hospice stays, yet we do not know whether changes moved a patient closer to or further away from their optimum use of the benefit.

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cover image Journal of Palliative Medicine
Journal of Palliative Medicine
Volume 12Issue Number 8August 2009
Pages: 687 - 694
PubMed: 19591625

History

Published online: 7 August 2009
Published in print: August 2009
Published ahead of print: 10 July 2009

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Courtney Harold Van Houtven
Center for Health Services Research and Development in Primary Care, VA Medical Center, Durham, North Carolina.
Division of General Internal Medicine, Duke University Medical Center, Durham, North Carolina.
Donald H. Taylor, Jr.
Center for Health Policy, Law and Management, Sanford School of Public Policy, Duke University, Durham, North Carolina.
Karen Steinhauser
Center for Health Services Research and Development in Primary Care, VA Medical Center, Durham, North Carolina.
Center for Health Policy, Law and Management, Sanford School of Public Policy, Duke University, Durham, North Carolina.
Center for Palliative Care, Duke University, Durham, North Carolina.
James A. Tulsky
Center for Health Services Research and Development in Primary Care, VA Medical Center, Durham, North Carolina.
Division of General Internal Medicine, Duke University Medical Center, Durham, North Carolina.
Center for Palliative Care, Duke University, Durham, North Carolina.

Notes

Address correspondence to:
Courtney Harold Van Houtven, Ph.D.
HSR&D
Durham VAMC
508 Fulton Street
Durham, NC 27705
E-mail: [email protected]

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