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J Palliat Med. 2008 Apr;11(3):484-91. doi: 10.1089/jpm.2007.0149.

Ethnic variation in timing of hospice referral: does having no informal caregiver matter?

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  • 1Department of Health Administration, Governors State University, University Park, Illinois 60466, USA.



The length of hospice stay, as an indicator of timing of hospice referral, is an important outcome to examine in end-of-life care because it is relevant to the quality and cost efficiency of end-of-life care that patients receive. Although the majority receives nonmedical care from informal caregivers, many elderly hospice users rely on paid caregivers or staff of residential facilities.


This study examined whether availability of informal primary caregiver interact with ethnicity to affect length of hospice stay.


A retrospective cross-sectional study.


Data on 3024 hospice patients aged 65 and older discharged between 1997 and 2000 was extracted from the National Center for Health Statistics' National Home and Hospice Care Survey (NHHCS).


Length of hospice stay prior to death or discharge.


Survival analysis revealed that among patients with formal caregivers, minority patients were likely to have significantly shorter hospice stays than non-Hispanic whites. There were no significant ethnic differences in length of stay among patients with informal caregivers.


Our findings suggest that ethnic differences in length of stay should be discussed in terms of type of caregiver, not just type of setting, since patients in residential facilities can have informal primary caregivers who are vigilant advocates for their dying relatives. We discuss possible reasons for the influence of having formal caregivers on length of stay of minority elders.

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