Hospices that see higher numbers of patients in assisted living facilities tend to have lower quality scores than other providers, research has found.

Hospice providers with higher volumes of assisted living-based patients are 7% more likely to receive lower quality scores than those in other settings, according to a recent study, published in the Journal of the American Geriatrics Society.

The findings point to possibly growing gaps of unmet needs among hospice patients in assisted living (AL) settings, according to the researchers.

“More attention and resources should be distributed to AL residents,” the researchers told Hospice News in an email. “AL residents are becoming increasingly older and frail, and a majority of them may need help with activities of daily living. Hospice providers should ensure that AL residents have equal access to quality services like residents in other referral settings.”

Researchers from the University of Rochester School of Medicine and Dentistry recently dug into hospice decedent data spanning 2019 – 2020 to examine differences in quality across various care settings. Comparisons included examination of various hospice providers’ Medicare claims data, Hospice Item Set (HIS) results and Consumer Assessment of Healthcare Providers & Systems (CAHPS) surveys.

The study compared patient outcomes in assisted living and skilled nursing facilities, inpatient hospice and hospital-based settings, as well as in the home, among others.

Quality scores were 7% lower in the areas such as pain assessment, dyspnea treatment and emotional support among hospice providers with more patients in assisted living settings versus others, the study found. These hospices were 5% less likely to have higher CAHPS scores and 7% less likely to have higher HIS scores.

The study also found that caregivers of patients in assisted living settings rated hospice providers lower in terms of communication and family caregiving training.

“We found that AL residents typically receive hospice services from lower quality hospice providers,” researchers said. “High AL-volume hospice providers performed worse in the quality measures related to team communication, training family members to provide care and the assessment and treatment of patient conditions.”

Other findings indicated that nonprofits and “larger providers” had higher quality scores in assisted living settings.

More research is needed to better understand quality outcomes and ties between referral patterns among assisted living providers and hospices, the researchers indicated.

“Our findings on the relationship between AL volume and quality of hospice care persisted even after we controlled for the profit status and size of the hospice provider,” researchers told Hospice News. “It is likely that some other factors may have drawn lower-quality hospice agencies to ALs. Future research is still needed to understand the contributing factors of lower-quality hospice providers concentrating on the AL market, especially the referral patterns from ALs to hospice providers.”