The Impact of Hospice and Dementia Special Care Units on End-of-Life Care for Individuals with Dementia

Hospice and Dementia Special Care Units (DSCUs) have been shown to be gold standards of care for individuals who are dying and for those with dementia in nursing homes. Using a retrospective administrator and family survey, this study investigated whether the processes of care used in hospice and DSCUs are associated with increased quality of end of life (EOL) care for individuals with dementia. A convenience sample of 17 facilities in four states (FL, PA, MD and MA) was included in the study. Nursing home administrators were surveyed between September 2008 and October 2009. The administrators identified 116 family members of decedents with dementia who were surveyed with the End-of-Life Dementia (EOLD) scale as the outcome. The Donabedian Structure-Process-Outcome theory was used to test the hypothesis that the process characteristics of hospice and DSCU will be associated with higher EOLD scores. Hierarchical regression models were conducted for two of the three subscales of the EOLD. The resident risk characteristics (decedent length of stay and resident immobility), the structure characteristics (profit status, percent Medicaid and presence of other palliation), and the process characteristics (hospice, DSCU, dual, and traditional enrolled, and strength of inter-disciplinary team (IDT)] were entered into the model to determine their association with Satisfaction With Care and Comfort At Death. Strength of the IDT was included as a moderating factor of this association. Only DSCU enrollment was associated with increased Satisfaction With Care (SWC; DSCU: b = .31, p < .01). The moderation analysis showed that strength of IDT did significantly moderate the association between DSCU enrollment and increased SWC (DSCU: b = -.09, p < .05). Study implications include the need for more research into DSCUs and Strength of IDT as best practices in EOL care. This study contributes to an expanding body of research on the extra value of enrollment in a DSCU and the role of IDT in quality of EOL care for individuals with dementia in nursing homes