Center for Gerontology and Healthcare Research, Brown University School of Public Health, Providence, RI, USA.
Center for Gerontology and Healthcare Research, Brown University School of Public Health, Providence, RI, USA; Department of Health Services, Policy, & Practice, Brown University School of Public Health, Providence, RI, USA; Providence VA Medical Center, Providence, RI, USA.
J Am Med Dir Assoc. 2023 Jun;24(6):911-916.e6. doi: 10.1016/j.jamda.2023.03.028. Epub 2023 Apr 3.
Hospice aides are vital in delivering care to patients and family members at the end of life. The COVID-19 pandemic resulted in disruptions in hospice care delivery, especially in long-term care settings. We aim to provide a description of hospice aide visits among nursing home residents enrolled in hospice during the first 9 months of 2020, as compared with the same months in 2019.
Observational cohort study.
153,109 and 152,077 long-stay nursing home residents enrolled in hospice in 2019 and 2020, respectively.
On a monthly basis, we reported estimated probabilities of not having visits from hospice aides and adjusted visit minutes among those who had hospice aide visits for the 2019 and 2020 cohort, respectively. The regression models accounted for resident sociodemographic and clinical characteristics and nursing home fixed effects. The analyses were conducted at the national and state level, separately.
More than half of residents did not have any visits from hospice aides in 2020 from April and onward. Among residents who had hospice aide visits, the 2020 cohort had reduced visits in March and onward, with the greatest difference being 155 minutes less in April (95% CI: -163.4, -146.5). State-level analyses suggested that multiple factors besides community spread or state policies might contribute to the reduced presence of hospice aides.
Our findings highlight the toll of the pandemic on hospice care delivery in nursing homes and the need for hospice care to be better incorporated into emergency preparedness planning.
临终关怀助手在为生命末期的患者和家属提供护理方面至关重要。COVID-19 大流行导致临终关怀服务的中断，尤其是在长期护理环境中。我们旨在描述在 2020 年前 9 个月入住临终关怀的养老院居民中的临终关怀助手访问情况，并与 2019 年同期进行比较。
观察性队列研究。
分别有 153109 名和 152077 名长期居住在养老院的居民在 2019 年和 2020 年入组临终关怀。
每月报告 2019 年和 2020 年队列中没有临终关怀助手访问的估计概率以及有临终关怀助手访问的患者的调整访问分钟数。回归模型考虑了居民的社会人口统计学和临床特征以及养老院固定效应。分析分别在国家和州一级进行。
2020 年 4 月及以后，超过一半的居民没有任何临终关怀助手的访问。在有临终关怀助手访问的居民中，2020 年队列中的访问量从 3 月及以后减少，最大差异为 4 月减少 155 分钟（95%CI：-163.4，-146.5）。州级分析表明，除了社区传播或州政策之外，还有多种因素可能导致临终关怀助手的减少。
我们的研究结果突出了大流行对养老院临终关怀服务的影响，需要更好地将临终关怀纳入应急准备计划。
