Objectives: To determine predictors of dying in VA nursing homes, community living centers (CLCs), compared with dying in a hospital.
Design: Retrospective cohort study.
Setting: VA CLCs.
Participants: Included were 7408 CLC decedents from FY2005 to FY2007.
Outcome: Site of death obtained from VA Vital Statistics files. Predictors of Death Site: VA-MDS variables defining patient demographics, functional status, cognitive status, major diagnostic categories, and care planning documentation.
Analysis: Logistic regression was used to estimate the odds ratio of death in the CLC relative to the hospital for patient and facility characteristics.
Results: Among decedents, 87% died in the CLC and 13% in a hospital. More than half of all decedents were neither enrolled in hospice nor designated as having end-stage disease. The strongest predictor of site of death in a CLC relative to a hospital was being enrolled in hospice (OR = 20.94; 95% CI: 12.38, 35.44). A designation of end-stage disease increased the odds of death in a CLC by 3.9 times (95% CI: 2.78, 5.47) compared with death in a hospital. Advance directive rates in CLCs were high (73.4%); having any advance directive increased the odds of death in a CLC by 1.57 times (95% CI: 1.35, 1.82).
Conclusion: Recognition of end-stage disease and documentation of advance directives are powerful determinants of site of death for CLC residents. Receipt of hospice care in a CLC is a strong predictor of site of death in a CLC even in the absence of collaboration with community-based hospice and financial incentives to avoid hospitalization.
Published by Elsevier Inc.