Less Hospice Use and Shorter Hospice Lengths of Stay for Connecticut Medicaid Decedents with Short-Term and Long-Term Nursing Home Stays Compared with Decedents Remaining in Community Homes

Background: The relationship between nursing home (NH) stays before death and hospice use is understudied. Methods: A retrospective cohort study of Connecticut Medicaid decedents with common hospice diagnoses who died between 2017 and 2020. Medicaid/Medicare claims identified NH stays, hospice use, short length of stay (LOS) (≤7 days), demographics, and diagnoses. Logistic regression models examined associations between NH stays with hospice use and LOS. Results: Among 26,261 decedents, 54.2% had NH stays (17.8% short-term, 36.4% long-term). Individuals with NH stays (vs. none) had reduced odds of hospice use (short-term odds ratio [OR]: 0.77 [95% confidence interval or CI: 0.71-0.82] and long-term OR: 0.47 [0.45-0.50]) and had higher odds of short hospice LOS (short-term OR: 2.67 [2.41-2.96] and long-term OR: 2.95 [2.69-3.22]). Conclusions: Further research is needed into why individuals with NH stays, especially long-term stays, are less likely to use hospice and more likely to have short LOS and how this difference relates to end-of-life care quality.