Icahn School of Medicine at Mount Sinai, New York, New York, USA.
Adelphi University College of Nursing and Public Health, New York, New York, USA.
J Palliat Med. 2024 Aug;27(8):1018-1025. doi: 10.1089/jpm.2023.0585. Epub 2024 Apr 22.
Hospice care frequently includes hands-on care from hospice aides, but the need for hospice aide care may vary in residential settings (e.g., assisted livings and nursing homes). The objective of this study is to compare hospice aide use and factors associated with use across residential settings. This longitudinal cohort study used data from Medicare beneficiaries in the United States enrolled in the Medicare Current Beneficiary Survey (MCBS) who died between 2010 and 2019 and had hospice claims and available residential setting data in MCBS ( = 1,915). Decedent hospice aide use was compared by residential settings; multivariable models controlling for sociodemographic, clinical/functional, and hospice characteristics examined factors associated with hospice aide care in different residential settings. Hospice aide visits were least common in the community setting (64.4% vs. 76.6% vs. 72.6% with any hospice aide visits in community, assisted living, and nursing home, respectively, = 0.001). In adjusted models, factors associated with hospice aide visits did not significantly differ by residential settings. Despite staff providing hands-on support in assisted livings and nursing homes, hospice aide visits were more common in residential as opposed to community settings, and factors associated with hospice aide visits were similar among settings. To maximize the potentially positive impact of hospice aides on overall care, additional work is needed to understand when hospice aides are used and how hospice aides collaborate with families and care teams. This will help to ensure that hospice care is appropriately tailored to individual care needs in all residential settings.
临终关怀护理通常包括临终关怀助理的实际护理，但在居住环境中（如辅助生活和疗养院），对临终关怀助理护理的需求可能会有所不同。本研究的目的是比较居住环境中临终关怀助理的使用情况和与使用相关的因素。这项纵向队列研究使用了来自美国医疗保险受益人的数据，这些受益人参加了 Medicare 现行受益人调查（MCBS），他们在 2010 年至 2019 年间死亡，并且在 MCBS 中有临终关怀索赔和可用的居住环境数据（=1915）。根据居住环境比较了死者临终关怀助理的使用情况；多变量模型控制了社会人口统计学、临床/功能和临终关怀特征，检查了不同居住环境中与临终关怀助理护理相关的因素。社区环境中临终关怀助理的访问量最少（分别为 64.4%、76.6%和 72.6%，在社区、辅助生活和疗养院有任何临终关怀助理访问，=0.001）。在调整后的模型中，与临终关怀助理访问相关的因素在居住环境中没有显著差异。尽管工作人员在辅助生活和疗养院提供实际支持，但与社区环境相比，临终关怀助理的访问量更多，与临终关怀助理访问相关的因素在各环境中相似。为了最大限度地发挥临终关怀助理对整体护理的积极影响，需要进一步努力了解何时使用临终关怀助理以及临终关怀助理如何与家庭和护理团队合作。这将有助于确保在所有居住环境中，根据个人护理需求适当调整临终关怀护理。
