Hospice Satisfaction in Nursing Homes Lags Behind Other Long-Term Care Settings

The perceived quality of hospice care in nursing homes (NHs) compared poorly to other settings such as home health and assisted living, according to a new study from the Indiana University Center for Aging Research and the Regenstrief Institute.

Kathleen Unroe of Indiana University and colleagues examined 7,510 survey responses to the Family Evaluation of Hospice Care, a federally mandated quality survey for the study, which was published in the Journal of the American Geriatrics Society.

Overall, hospice quality was rated as “excellent” by 63% of survey respondents, but hospice care for family members in NHs was the least likely to be regarded as excellent. In fact, just 55.1% of family members of those who received hospice care in nursing facilities reported it to be excellent. They were also more likely to report that patients in hospice in NHs did not die in the setting of their choice.


By comparison, 67.8% of family members of those who received care at home reported the hospice care as excellent, while 64.3% of family members of patients in assisted living facilities (ALFs) made the same assessment.

The disparity in perception of hospice care quality could have several causes, however, and it can’t be taken to mean necessarily that hospice care in skilled nursing facilities is inferior.

“Concerns about quality of NH care and individuals’ unhappiness with being in that setting, which serves as a safety net for people who do not have adequate support at home, may be reflected in these responses and thus not be a true measure of perceptions of the quality of hospice care provided,” the authors wrote.


Integrating hospice care into the NH setting has been challenging, they added, and coordinating care plans and fostering communication between NH and hospice staff can be a problem. This could contribute to perceptions of inferior quality of care, as families can have a hard time telling the difference between care provided by hospice staff and care provided by the nursing home staff, the authors said.

The study was limited in that the sample was derived from just one provider, and the practices of other hospice providers could differ. The sample was also limited to those who received routine hospice care and lived in one setting towards the end of their lives; those who transitioned between care settings near the end of life could be more vulnerable to disruptions that affected care quality.

But SNFs can still learn from the findings, particularly where information-sharing is concerned.

“Staff generally provide daily care in NH or ALFs, which may distance family members from day-to-day treatment discussions,” the authors concluded. “Hospice providers may need to customize communication strategies based on setting.”

Written by Maggie Flynn

Companies featured in this article: