Home Health Care And Discharged Hospice Care Patients .
Number 38 n April 27, 2011Home Health Care and Discharged Hospice CarePatients: United States, 2000 and 2007by Christine Caffrey, Ph.D.; Manisha Sengupta, Ph.D.; Abigail Moss; Lauren Harris-Kojetin, Ph.D.; andRoberto Valverde, M.P.H., Division of Health Care StatisticsAbstractObjectives—This report presents national estimates on home health carepatients and discharged hospice care patients. Information on characteristics,length of service, medical diagnoses, functional limitations, service use, advancecare planning, and emergent and hospital care use are presented for home healthcare patients and hospice care discharges. A comparison of selectedcharacteristics for 2000 and 2007 is also provided to highlight changes.Methods—Estimates are based on data collected on agencies from the 2000and 2007 National Home and Hospice Care Survey, conducted by the Centers forDisease Control and Prevention’s National Center for Health Statistics. Estimatesare derived from data collected during interviews with administrators and staffdesignated by the administrators.Results—Each day in 2007, there were an estimated 1,459,900 home healthcare patients. They were predominantly aged 65 years or over, female, and white.Their mean length of service was 315 days, and their most common primarydiagnosis at admission was diabetes mellitus. About one-fourth of them hadadvance care planning and one-fifth had at least one overnight hospital stay sinceadmission to the home health care agency. In 2007, there were 1,045,100discharged hospice care patients. The majority of discharged patients were aged65 or over, female, and white, and most were discharged deceased. Their meanlength of service was 65 days, and the most common primary diagnosis atadmission was malignant neoplasm. Most of them had advance care planning,and about one-fourth had three or more types of advance care planninginstruments.Keywords: National Home and Hospice Care Survey patient characteristics advance care planning long-term careIntroductionBy 2050, an estimated 27 millionpeople will need some type of long-termcare (1). Of those 27 million, themajority will receive long-term care inthe community. Home health andhospice care agencies are majorproviders of formal, community-basedlong-term care. Currently, about 7.6million people receive community-basedcare to help with post-acute and chronicconditions, disabilities, or terminalillnesses (2). This number is expected toincrease as the population ages and thedesire to ‘‘age in place’’ continues (3–5).Older Americans will increasinglyconstitute a larger percentage of thepopulation in the future—from about12% in 2006 to almost 20% in 2030 (6).The majority of people using homehealth and hospice care services areover age 65 years (7). Most of themhave multiple chronic conditions, andhome health and hospice care servicesenable many of them to receive servicesin their homes and communities (4).Home health care includes a rangeof medical and therapeutic services aswell as other services delivered at apatient’s home or in a residential settingfor promoting, maintaining, or restoringhealth, or maximizing the level ofindependence, while minimizing theeffects of disability and illness. Hospicecare emphasizes relieving pain anduncomfortable symptoms of personswith terminal illness and providingemotional and spiritual support to boththe terminally ill and their familymembers.Despite the growth in home healthand hospice care, and the projectedincreased demand for these services,national data on long-term carerecipients are limited. This reportattempts to fill this gap by presentingU.S. DEPARTMENT OF HEALTH AND HUMAN SERVICESCenters for Disease Control and PreventionNational Center for Health Statistics
Page 2summary information on home healthcare patients and discharged hospicecare patients. The figures and tablespresent characteristics, length of service,medical diagnoses, functionallimitations, service use, advance careplanning, and emergent and hospitalcare use for both groups of patients.Data from 2000 and prior years havebeen published previously (7–10). Thisreport presents estimates from 2007 andhighlights changes between 2000 and2007. Selected longer-term trends arealso presented.MethodsThe data in this report are from theNational Home and Hospice CareSurvey (NHHCS), which has beenconducted periodically since 1992 bythe Centers for Disease Control andPrevention’s National Center for HealthStatistics. Most of the statistics in thisreport are based on informationcollected in 2000 and 2007 (7–10).NHHCS is a national probabilitysample survey that collects data on U.S.home health and hospice care agencies,their staff members, the services theyprovide, and the people they serve.Agencies that provided home health orhospice care services at the time of thesurvey were eligible to participate inNHHCS. Up to 10 patients wererandomly selected per home health care,hospice care, or mixed agency. Currenthome health care patients were definedas patients who were on the rolls of theagency as of midnight of the dayimmediately before the agencyinterview. Discharged hospice carepatients were defined as patients whowere discharged from the hospiceagency during the 3-month periodbeginning 4 months before the agencyinterview.The 2007 NHHCS represents aredesign from previous NHHCS years,including many new data items (such asadvance care planning and emergentcare), and collecting data using acomputer-assisted personal interviewing,or CAPI, system. Nonetheless, all datacollection years of NHHCS shareimportant common features: cases inNHHCS for each survey year wereNational Health Statistics Reports n Number 38 n April 27, 2011associated with a sample weight,whereby national estimates can be madereflecting the composition of U.S. homehealth and hospice care agencies in eachsurvey year; and many core data itemswere collected in a consistent manner.These core items include selectedpatient characteristics and the receipt ofselected services; many of these arepresented in this report. For furtherinformation on the sampling, surveydesign, and other survey methodology,see ‘‘Technical Notes’’ in this report andthe documentation for each survey yearavailable from: http://www.cdc.gov/nchs/nhhcs.htm.Data analysisAll analyses were performed inSAS-callable SUDAAN (11) to accountfor sampling weights and the complexsampling design. Chi-square tests andt tests were used to test for statisticalsignificance at the p 0.05 level. Noadjustments were made for multiplecomparisons. Terms such as ‘‘similar’’or ‘‘no significant differences’’ are usedto denote that the estimates beingcompared are not significantly differentstatistically. Comparisons not mentionedmay or may not be statisticallysignificant. A weighted least squarestechnique was used (12) to test lineartrends across survey years. A downwardor upward trend is mentioned if it isstatistically significant. For length ofservice changes between 2000 and 2007,t tests were done for means andmedians.Nonresponses (e.g., ‘‘don’t know’’and ‘‘refused’’) for categorical variableswere recoded as unknown and includedin analyses. Among home health carepatients, the percentage of cases withnonresponses ranged from 0.1% forpayment source in 2007 to 6.2% forHispanic or Latino origin in 2007.Among discharged hospice care patients,the percentage of cases withnonresponses ranged from 0.1% forcertification status of the hospice careprovider in 2007 to 4.1% for Hispanicor Latino origin in 2007. When 5% ormore of the responses are unknown, anunknown category is included in thetables. When an unknown category hasless than 5% nonresponse, the unknowncategory is not reported in the tables.Unknowns are included in thedenominators for percent distributionestimates regardless of the percentageunknown and whether they are reportedin the table. Except where noted, figuresdepicting percentages also include theunknown category in the denominator,even when the unknown category itselfis not depicted in the figure. For thisreason, category-specific sample sizesmay sum to less than table or figuretotals, and percent distributions maysum to less than 100%.Unknowns were excluded for thecontinuous variables: length of service,total number of activities of daily living(ADLs) limitations, number of ADLswith which staff assist, and number ofadvance care planning instruments.Among home health care patients, thepercentage of cases with nonresponsesfor length of service was 0.6% and fornumber of advance care planninginstruments, 3.0%. Among dischargedhospice care patients, the percentage ofcases with nonresponses for length ofservice was 0.2% and for number ofadvance care planning instruments,1.7%. See footnotes in tables andfigures for further detail on howunknowns were handled.ResultsHome health care patientsCharacteristics Each day in 2007, there were anestimated 1,459,900 home health carepatients (Table 1). This is an increasefrom 2000, when each day there were1,355,300 home health care patients(data not shown). A majority of homehealth care patients lived with familyor nonfamily members (68.5%). Most home health care patients wereaged 65 or over (68.7%). About 6 outof 10 (64.0%) home health carepatients were women. About 8 out of10 (81.7%) patients were white. In 2007, more than one-half of allpatients (55.2%) received carethrough proprietary agencies, 38.3%through voluntary nonprofit agencies,and the remaining 6.5% through
National Health Statistics Reports n Number 38 n April 27, 2011government or other agencies. From2000 through 2007, there was anincrease in the percentage of patientsreceiving care through proprietaryagencies (34.1% in 2000 and 55.2%in 2007) and a related decrease in thepercentage receiving care throughvoluntary nonprofit agencies (56.6%in 2000 and 38.3% in 2007); therewas no difference in government orother agencies (data not shown).Length of service During 2007, the mean length ofservice for home health care patientswas 315 days, with a median of 70days (Table 2). Mean length of service was longerfor patients who were under age 65(474 days) than for those 65 and over(242 days). Among patients youngerthan age 65, mean length of servicewas longer for patients who wereyounger than age 45 (692 days) thanfor those aged 45–64 (326 days). Among the oldest-old patients (aged85 and over), mean length of servicedecreased from 419 days in 2000 to270 days in 2007; median length ofservice decreased from 155 days in2000 to 91 days in 2007 (Figure 1). On average, patients receiving carefrom proprietary agencies had alonger mean period of service (374days) than patients receiving carePage 3from voluntary nonprofit agencies(203 days).Medical diagnosesPrimary diagnosis at admission In 2007, the most common primarydiagnoses at admission among homehealth care patients were diabetesmellitus (10.1%); heart disease(8.8%), including congestive heartfailure (4.3%); malignant neoplasm(3.9%); chronic obstructivepulmonary diseases and alliedconditions (3.4%); essentialhypertension (3.3%); andcerebrovascular disease (3.3%)(Table 3). Among home health care patients,10.1% had as their primary diagnosisa condition coded within the majordisease category of symptoms, signs,and ill-defined conditions; amongthese, the most common wasabnormality of gait due to symptomsinvolving the nervous ormusculoskeletal systems (4.3%) (datanot shown). Another 10.4% of home health carepatients had as their primarydiagnosis a condition coded withinthe supplementary classification usedfor posthospital aftercare; amongthese, the most common wasorthopedic aftercare (4.7%) (data daysMedian91days020002007NOTES: Percentages are based on unrounded numbers. Denominator does not include unknowns.SOURCE: CDC/NCHS, National Home and Hospice Care Survey, 2000 and 2007.Figure 1. Length of service for home health care patients aged 85 and over: United States,2000 and 2007All-listed diagnoses at interview Among all-listed diagnoses at thetime of interview, 41.1% of patientshad essential hypertension, 31.3% hadheart disease, 30.6% had diabetesmellitus, 13.5% had chronicobstructive pulmonary diseases andallied conditions, 10.0% hadosteoarthritis (except spine), 8.6%had a malignant neoplasm, 7.1% haddementia, and 7.1% hadcerebrovascular disease (Figure 2). Home health care patients had anaverage of 4.2 diagnoses per patientat the time of interview (data notshown).Limitations in activities of dailyliving Five ADLs—bathing, dressing,transferring, using the toilet room,and eating—that reflect the homehealth care patient’s capacity forself-care at interview were includedin this report. In 2007, 84.0% of home health carepatients had at least one ADLlimitation and 14.8% had no ADLlimitations (data not shown). Amonghome health care patients with atleast one ADL limitation, 50.5% hadfour to five limitations, 21.7% hadthree limitations, 16.5% had twolimitations, and 11.3% had onelimitation. Among home health carepatients with at least one ADLlimitation, a larger percentage ofthose living with others (54.7%) hadfour to five limitations compared withthose living alone (39.4%) (Figure 3). In 2007, among home health carepatients with at least one ADLlimitation, 48.0% were receiving nohelp with their limitation from homehealth care agency staff. Amonghome health care patients with atleast one ADL limitation, those livingwith others were more likely toreceive no ADL assistance fromagency staff compared with patientsliving alone (51.0% compared with40.6%).
National Health Statistics Reports n Number 38 n April 27, 2011Page teoarthritisobstructiveand alliedpulmonarydisorders,disease andexcept spineallied sculardiseaseNOTES: Percentages are based on unrounded numbers. Denominator includes unknowns.SOURCE: CDC/NCHS, National Home and Hospice Care Survey, 2007.Figure 2. Selected chronic conditions of home health care patients at interview: United States, 2007Number of ADLs1, by living arrangement, 200710010039.4808054.7Four or umber of ADLs1 requiring staff help, by living arrangement, 0.7Four or .816.94048.014.3Two8.6OneLivingwith others40.6200AllpatientsLivingaloneLivingwith others1Activities of daily living.NOTES: The denominator for all data is current home health care patients who had at least one ADL limitation at interview (84.0%). Percentages may not add to 100% due to rounding.Percentages are based on unrounded numbers. Denominator does not include unknowns.SOURCE: CDC/NCHS, National Home and Hospice Care Survey, 2007.Figure 3. Home health care patients with at least one limitation in activities of daily living, by living arrangement: United States, 2007Advance care planning During 2007, patients under age 45had a significantly lower likelihoodof having advance care planning atinterview than older patients (12.0%compared with 21.2% of those aged45–64 and 33.6% aged 65 or over)(Table 4, Figure 4). White home health care patients wereabout 2½ times as likely to haveadvance care planning as black homehealth care patients (32.0% comparedwith 12.5%). Living wills (16.8%) and durablepower of attorney (13.7%) were thetwo most common types of advancecare planning instruments reported forhome health care patients; about 8%(data not shown) of home health carepatients had both a living will and adurable power of attorney.Emergent care and hospital use More than one-tenth (12.7%) of homehealth care patients had at least oneemergent care service in the 60 daysbefore the agency interview(Figure 5). Of these patients, 87.4%
National Health Statistics Reports n Number 38 n April 27, 2011Page 0All home healthcare patientsUnder 4545–6465–7475–8485 BlackWhiteRaceAge at interviewNOTES: Percentages are based on unrounded numbers. Denominator includes unknowns.SOURCE: CDC/NCHS, National Home and Hospice Care Survey, 2007.Figure 4. Home health care patients with advance care planning at interview, by age and race: United States, 2007100YesNo86.477.3Percent80604021.42012.70Had at least one emergentcare service in past 60 daysHad at least one overnighthospital stay since agency admissionNOTES: Emergent care services Include hospital emergency room visits (including 23-hour holding), doctors' officeemergency visits or house calls, and outpatient department or clinic visits (including urgent care center sites).Percentages may not add to 100% because of rounding and inclusion of unknowns in percent distribution. Percentagesare based on unrounded numbers.SOURCE: CDC/NCHS, National Home and Hospice Care Survey, 2007.Figure 5. Use of emergent care services and overnight hospital stays for home healthcare patients: United States, 2007visited a hospital emergency room(data not shown). More than one-fifth (21.4%) of homehealth care patients had at least oneovernight hospital stay sinceadmission to the home health careagency.Discharged hospice carepatientsCharacteristics During 2007, there were 1,045,100patients discharged from hospice care,a 68% increase since 2000 whenthere were 621,000 patientsdischarged from hospice care (datanot shown for 2000). The mostcommon reason for discharge wasdeath (84.3%); the remaining 15.6%were discharged because theircondition had stabilized and they nolonger needed services, or becausethey were transferred to an inpatientcare or another hospice care facility(Table 5). The majority of discharged hospicecare patients were aged 65 and over(83.1%). Discharged patients werepredominantly white (90.7%) and notof Hispanic or Latino origin (91.9%).In 2007, there were more women(55.1%) among discharged hospicecare patients than men (44.9%)—achange from 2000, when there wasno significant difference by sex (datanot shown for 2000). Most of the discharged patientsreceived services from a voluntarynonprofit agency (66.7%), andanother 31.2% received care fromproprietary agencies. Although therelative number of discharged patientsreceiving services in proprietaryagencies increased in 2007 from2000, the percentage receivingservices in proprietary agenciesalmost doubled, from 15.8% in 2000to 31.2% in 2007; a related decreasewas evident among those receivingservices through voluntary agencies(80.0% in 2000 and 66.7% in 2007)(Figure 6). In 2007, about one-quarter(27.2%) of discharged patients
National Health Statistics Reports n Number 38 n April 27, 2011Page vernmentor otherOwnershipChainaffiliatedNot chainaffiliatedChain affiliation†Estimate does not meet standards of reliability or precision because the sample size is between 30 and 59, or the samplesize is greater than 59 but has a relative standard error of 30 percent or more.NOTES: Percentages may not add to 100% because of rounding and inclusion of unknowns in percent distribution.Percentages are based on unrounded numbers.SOURCE: CDC/NCHS, National Home and Hospice Care Survey, 2000 and 2007.Figure 6. Discharged hospice care patients, by selected agency characteristics:United States, 2000 and 200780Malignant neoplasms74.769.06069.757.264.8Percent57.540All other 3019921998NOTES: Percentages are based on unrounded numbers. Denominator includes unknowns.SOURCE: CDC/NCHS, National Home and Hospice Care Survey, 1992, 1994, 1996, 1998, 2000, and 2007.Figure 7. Discharged hospice care patients, by primary admission diagnosis:United States, selected years, 1992–2007received care from chain-affiliatedagencies, a decrease from 2000 when41.5% of discharged patients receivedservices from chain affiliates.Le
health and hospice care services many of them to receive services in their homes and communities (4). Home health care includes a range of medical and therapeutic services as well as other services delivered at a patient’s home or in a residential setting for promoting, maintaining, or restoring health, or maximizing the level of
4 Current Drivers of Home-Based Medical Care Models 5 The Opportunity 6 The Spectrum of Home-Based Medical Care Models Table 1. Longitudinal Home-Based Medical Care Models Table 2. Episodic Home-Based Medical Care Models The Bottom Line 12 Case Studies 15 Looking Ahead: An Integrated Home- and Community-Based Health Care Ecosystem 16 Endnotes .
Figure 14 Mass sediment discharged over time for the median log capture coconut fiber log, C1C (B). . 39. Figure 15 Mass sediment discharged over time for the median log capture straw log, S2 (A). . 40 Figure 16 Mass sediment discharged over time for one of the two median wood fiber logs, W1 (A). Four .
Home health care agencies are an increasingly important source of long-term care, and 33% of people receiving home health care in 2007 had diabetes. The prevalence of diabetes is highest for home health care patients age 65-74 years. Home health care patients with diabetes are more likely to be middle-aged and nonwhite than patients without .
Understanding home care Key terms explained Home Care Package – The Home Care Package program is a government-subsidised program that provides support for older people who want to stay living at home. There are four levels of Home Care Packages, ranging from basic care needs to high care
Long-Term Care Implications – Some Scenarios and Issues for the State . Specialty Care – Behavioral Health Care – Urgent and Emergent Care – Inpatient Acute Care – Home Care and Nursing Home Sub-Acute and – Long-Term Care 16 . Improving Performance: Improving Care and Population Health, Reducing Costs
identify designated long-term care facilities for discharged COVID-19 patients, or otherwise set clear pathways to streamline hospital to long-term care transfers. Educating patients and their loved ones on patient rights when the patient originated from a long-term care facility or is being discharged to one.
Primary Health Care Providers Primary care includes health promotion, disease prevention, health maintenance, counseling, patient education, diagnosis and treatment of acute and chronic illnesses in a variety of health care settings (office, inpatient, critical care, long-term care, home care, day care, etc.). Primary care is performed and
AUTOMOTIVE THERMAL MANAGEMENT TECHNOLOGY 2 INTERNATIONAL COUNCIL ON CLEAN TRANSPORTATION WORKING PAPER 2016-18 BACKGROUND Automakers are applying new powertrain technolo-gies in order to meet government regulations. Thermal management techniques can improve powertrain and passenger comfort system efficiencies and are also
