Current patient–is
a patient on the hospice agency's roster as of the night before the survey.
Discharge–is a patient
formally discharged from care by the home health agency or hospice during a
designated month randomly selected for each agency prior to data collection.
Both live and dead discharges are included. A patient can be counted more
than once if the patient was discharged more than once during the reference
period; therefore, discharges represent episodes of care rather than
patients.
Terms Relating To
Agencies
Hospice care–is a program
of palliative and supportive care services providing physical,
psychological, social, and spiritual care for dying persons, their families,
and other loved ones. Hospice services are available in both the home and
inpatient settings. Home hospice care is provided on part‑time,
intermittent, regularly scheduled, and around‑the‑clock basis. Bereavement
services and other types of counseling are available to the family and other
loved ones.
Certification–refers to
agency certification by Medicare and/or Medicaid. Both programs can certify
hospices as meeting agency conditions for participation. Conditions for
participation address issues of professional management, the plan and
continuation of care, informed consent, in-service training of staff,
licensure, short-term inpatient care, and staffing of qualified personnel.
Specific information on each of these
areas and several others can be found on Title 42, Part 418, Subparts A–H.
Medicare–is the medical
assistance provided in Title XVIII of the Social Security Act. Medicare is a
health insurance program administered by the Centers for Medicare and
Medicaid Services for persons 65 years and over and for disabled persons who
are eligible for benefits.
Medicaid–is the medical
assistance provided in Title XIX of the Social Security Act. Medicaid is a
Federal/State administered program for the medically indigent.
Geographic region–refers
to the four geographic regions of the United States that correspond to those
used by the U.S. Census Bureau.
Northeast–Connecticut,
Maine, Massachusetts, New Hampshire, New Jersey, New York, Pennsylvania,
Rhode Island, and Vermont
Midwest–Illinois,
Indiana, Iowa, Kansas, Michigan, Minnesota, Missouri, Nebraska, North
Dakota, Ohio, South Dakota, and Wisconsin
South–Alabama, Arkansas,
Delaware, District of Columbia, Florida, Georgia, Kentucky, Louisiana,
Maryland, Mississippi, North Carolina, Oklahoma, South Carolina, Tennessee,
Texas, Virginia, and West Virginia.
West–Alaska, Arizona,
California, Colorado, Hawaii, Idaho, Montana, New Mexico, Nevada, Oregon,
Utah, Washington, and Wyoming.
Location–is classified
as inside a metropolitan statistical area (MSA) or outside an MSA.
Metropolitan statistical
area–is the definition established by the U.S. Office of Management and
Budget with advice of the Federal Committee on Metropolitan Statistical
Areas. Generally, an MSA consists of a county or group of counties
containing at least one city (or twin cities) having a population of 50,000
or more plus adjacent counties that are metropolitan in character and
economically and socially integrated with the central city. In New England,
towns and cities rather than counties are the units used in defining MSAs.
There is no limit to the number of adjacent counties included in the MSA if
they are integrated with the central city, nor is an MSA limited to a single
State. The metropolitan population in this report is based on MSAs as
defined in the 1980 census and does not include any subsequent additions or
changes.
Non-MSA–includes all
other places in the United States.
Ownership–refers to the
type of organization that controls and operates the home health agency or
hospice.
For profit–is operated
under private commercial ownership, including individual or private
ownership, partnerships, or corporations.
Nonprofit and
others–includes voluntary or nonprofit (including church-related and
nonprofit corporations); Federal, State, or local government; all other
types of ownership; and unknown.
Terms Relating To
Patients and Discharges
Demographic items
Age–is the patient's age
at the time of the interview (for current patients) or at the time of
discharge (for discharges). Age is calculated as the difference in years
between the date of birth and the date of admission interview or discharge.
Age is reported in whole years.
Race–refers to the
patient's race background as reported by agency staff. The race categories
listed in this report consist of the categories “White,” “Black and other,”
and “Black.” “Other race” includes Asian, Native Hawaiian or other Pacific
Islander, American Indian or Alaska Native, and multiple races. All race
categories include persons of Hispanic and not Hispanic origin. Persons of
Hispanic origin may be of any race. Starting with data year 1999,
race-specific estimates have been tabulated according to 1997 Standards for
Federal Data on Race and Ethnicity and are not strictly comparable with
estimates for earlier years. Only a small number of records had multiple
races indicated.
Hispanic or Latino
origin–refers to a person of Mexican, Puerto Rican, Cuban, Central or South
American, or other Spanish culture or origin, regardless of race, as
reported by agency staff.
Marital status–refers to
the marital status at the time of the interview (for current patients) or at
the time of discharge (for discharges).
Residence–is where the
patient is currently living (for current patients) or was living during the
episode of care before discharge (for discharges).
Private or semiprivate
residence–includes private residence (house or apartment, rented or owned);
rented room or boarding house (open to anyone as defined by the landlord for
rental payment); and retirement home (a facility that provides room and
board to elderly or impaired persons).
Board and care or
residential care facility–includes a facility that has 3 beds or more that
provides 24-hour supervision, provision, and oversight of personal and
supportive services (assistance with activities of daily living and
instrumental activities of daily living), and health-related services.
Health facility–includes nursing homes, hospitals, or other inpatient health
facilities
(including mental health facility).
Primary caregiver–is an
individual or organization that is responsible for providing personal care
assistance, companionship, and/or supervision to the patient.
Activities of daily
living–refers to six activities (bathing, dressing, transferring, using the
toilet room, eating, and walking) that reflect the patient's capacity for
self‑care. The patient's need for assistance with these activities is
measured by the receipt of help from agency staff at the time of the survey
(for current patients) or the last time service was provided prior to
discharge (for discharges). Help that a patient may receive from persons who
are not staff of the agency (for example, family members, friends, or
individuals employed directly by the patient and not by the agency) is not
included.
Instrumental activities
of daily living–refers to six daily tasks (light housework, preparing meals,
taking medications, shopping for groceries or clothes, using the telephone,
and managing money) that enables the patient to live independently in the
community. The patient's need for assistance with these activities is
measured by the receipt of help from agency staff at the time of the survey
(for current patients) or the last time service was provided prior to
discharge (for discharges). Help that a patient may receive from persons
that are not staff of the agency (for example, family members, friends, or
individuals employed directly by the patient and not by the agency) is not
included.
Primary expected source
of payment–is the one payment source expected to pay the greatest amount of
the patient's charges.
Private insurance, own
income, or family support–includes private health insurance (health
maintenance organization (HMO), independent practice association, or
preferred provider organization), family income, Social Security (including
Supplemental Security Income), retirement funds, or welfare. It does not
include Veterans Administration (VA) contracts, pensions, or other VA
compensation.
Medicare–is money
received under the Medicare program for home health or hospice care and may
be obtained through fee-for-service Medicare or Medicare HMO. Medicare is a
health insurance program for people 65 years of age and over, some disabled
people under 65 years of age, and people with end-stage renal disease
(permanent kidney failure treated with dialysis or a transplant). More
specific information can be found on the Centers
for Medicare and Medicaid Services Web site.
Medicaid–is money
received under the Medicaid Program for home health or hospice care and may
be obtained through fee-for-service Medicaid or Medicaid HMO. Medicaid
provides medical assistance for certain individuals and families with low
incomes and resources. Medicaid eligibility is limited to individuals who
fall into specific categories. Although the Federal government establishes
general guidelines for the program, Medicaid requirements are established by
each State. Whether a person is eligible for Medicaid will depend on the
State of residence. More specific information can be found on the Centers
for Medicare and Medicaid Services Web site.
All other
sources–includes religious organizations, foundations, Veterans
Administration contracts, pensions, or other VA compensation, and other
military medicine. The category also includes no charges for care, payment
sources not yet determined, and unknown sources.
Length of service–is
the number of days from the date of most recent admission to the date of the
survey interview for current patients: for discharges it is from the
admission date to the date of discharge for the selected episode of care.
Length of service for current patients tends to be an overestimate. This is
because samples of current patients are more likely to capture patients with
long lengths of service than those with short lengths of service. Patients
with short lengths of service are less likely to be included in a current
resident sample since they are less likely to be enrolled on a given day.
The length of service for discharges will be shorter than the length of
service for current patients since a sample of discharges will capture more
short stay episodes than a sample of current patients. It is also important
to remember that for discharges, length of service represents service for an
episode of care, rather than an individual patient. An individual may have
more than one episode of care during the period of discharges covered in
this study.
Average length of
service–is computed by adding the number of days of service and dividing the
total by the number of residents or discharges within the particular
category. This statistic is sensitive to extreme values (e.g., very low or
very high values), and is, therefore, best used with data that are
symmetrically distributed. The distribution for length of service is skewed;
therefore, both mean and median values are presented.
Median length of
service–is determined by identifying the midpoint of the distribution (50
percent of the cases fall above and below this value). This statistic is not
sensitive to extreme values and is used when data are skewed. The
distribution for length of service is skewed; therefore, both mean and
median values are presented.
Discharge disposition
Deceased–is a
patient/discharge who has died.
Recovered–occurs when
the condition or disease responsible for the patient/discharge’s need for
hospice care services is resolved.
Stabilized–occurs when
the condition or disease responsible for the patient/discharge’s original
need for hospice care services persists but the patient has improved and no
longer needs assistance.
Family/friends resumed
care–occurs when the condition/disease responsible for the patient/discharge’s need
for hospice care services assistance persists but the patient now receives
informal home care managed by family/friends.
Services no longer needed
and/or treatment plan completed–occurs when the reason for the
patient/discharge's need for hospice care is resolved (e.g., physical
therapy, health care training).
No longer eligible for
service and/or no longer homebound–occurs when the patient/discharge is
no longer eligible for hospice care services (e.g., no longer meets
definition of homebound or has exceeded the health insurance plan’s covered
benefits).