Healthcare utilization of nursing home residents: Comparison between decedents and survivors

OBJECTIVES: To determine whether residents who die while in the nursing home have higher healthcare utilization than survivors and whether the utilization in the periods before death varies with length of stay in the nursing home. DESIGN: Descriptive, longitudinal study comparing medical service use of residents who died during the study period with that of residents who remained alive in the facility. SETTING: Fifty-nine nursing homes in Maryland. Data were collected between 1992 and 1995. PARTICIPANTS: A random sample of 1,195 residents. MEASUREMENTS: Rates of hospitalization, emergency department visits, and medical visits in aggregate and in an initial 30-day and subsequent 90-day intervals after admission to the nursing home. RESULTS: Residents who died during the 2-year study period had significantly greater mean rates of utilization of all types of health care than residents who were not discharged from the nursing home, even when controlling for dementia diagnosis, age, functional status, and number of comorbid conditions. Those who died within a month of admission had significantly more emergency department and medical visits than those who died after a longer stay. CONCLUSION: The pattern of high healthcare utilization before death is consistent with studies of the overall Medicare population that show an increase in Medicare expenditures in the period before death.