The average length of stay before death was 13.7 months, while the median was five months. Fifty-three percent of nursing home residents in the study died within six months. Men died after an average stay of three months, while women died after an average stay of eight months. Before death, men spent an average of 790 days and women 1250 days in the corresponding nursing home.
Adjusted for previous hospitalizations, level of care, cause of death and multimorbidity, a low educational level, living alone or being a tenant, as well as a low level of care at admission, increased the risk of longer terminal stays. On the contrary, a high level of education, homeownership, being married, and a high standard of care at admission decreased the risk of longer stays. Medicare covers a portion of nursing home expenses up to 100 days, but only in a skilled nursing facility and nursing home stay must be preceded by an eligible hospital stay of more than three consecutive days. The length of time residents spend in a nursing home before death has important clinical and political implications.
Future prospective studies in this area are needed to further examine trends in end-of-life nursing home stay periods over time, and identify additional clinical and social indicators that may be significantly associated, such as functional status, expected prognosis, and admission and the number of hospital readmissions that take place before death. However, the length of this last stay in a nursing home depended not only on health-related factors, but also on a variety of social determinants. As a consequence, among residents of nursing homes and hospitalized people, linkage with the CNS was only possible for those who died in an institution. Since the average length of stay in a nursing home was less than one year, studies are also needed to examine the possible tax implications that the length of nursing homes may have for people interested in purchasing long-term care insurance.
According to the National Assisted Living Center (NCAL), of those currently residing in an Assisted Living community, 34% will move to a skilled nursing facility due to deteriorating health and 30% will die. The average amount of time people live in assisted living facilities, including memory care units, ranges from two to three years. Covariates included demographic, social and clinical factors extracted from the HRS interview conducted closer to the date of admission to the nursing home. Data from MDS can identify major factors associated with 1-year mortality in residents of newly admitted and long-term nursing homes.
The study authors used data from the Health and Retirement Study (HRS) to describe the length of stay of older adults residing in nursing homes at the end of life. While subjects resided in a nursing home at the end of life, the physical location of death was different for many. Moving to and dying in a nursing home depends not only on health, but also on an analysis of the socio-demographic determinants of the place of death in Switzerland.
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