Home Care Beats Assisted Living, Nursing Facilities in Hospice Satisfaction

Hospice care administered in the home is seen as higher quality than hospice care administered in an assisted living community or a nursing home, according to a new study from the Indiana University Center for Aging Research and the Regenstrief Institute.

The study, published in the Journal of the American Geriatrics Society, compared the quality of hospice services provided for patients living at home, in assisted living communities and in nursing homes, as perceived by their family members. In writing the study, researchers combed through the results of a federally mandated quality survey for 7,510 hospice patients over the age of 18.

The results showed that 67.8% of respondents reported that the home hospice care provider for their loved ones was “excellent,” beating out hospice care in assisted living communities (64.3%) and nursing homes (55.1%).


On the whole, 63.4% of respondents rated hospice quality as “excellent,” and 84.3% said their loved one’s hospice referral had occurred at the right time. The timing of hospice referrals has been a topic of concern for the industry, with a recent study from Yale University showing that many patients start hospice care only in the last two weeks of life.

In the Regenstrief study, 95% of all respondents felt that the hospice care their loved ones received was good, very good, or excellent.

“Lower perceived quality of hospice care in nursing homes may be related to general dissatisfaction with receiving care in this setting,” the study’s authors wrote. “Survey results have the potential to set priorities for quality improvement, choice of provider, and potentially reimbursement.”


The study is important because it shows subtle, but significant, differences in perceived quality of hospice care across different kinds of health care settings, according to the researchers. Quality measurement for hospice care has struggled to keep pace with the rapid expansion of those kind of services.

“In addition to providing actionable information to policy makers, clinicians, and additional interested parties, our findings may help hospice providers and others to tailor communication based on patient setting,” said Dr. Kathleen Unroe, in a press release. “As our population ages and more individuals receive hospice at home, in assisted living facilities and in nursing homes this is of critical importance.”

Although the study provides a window into the perspective of people whose loved ones died while receiving hospice services, a majority of families did not complete the survey, the researchers were careful to point out. There were also differences in completion rates based on length of stay, indicating the survey may not have adequately measured the quality of care for people with shorter hospice stays.

Written by Tim Regan

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