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National Home and Hospice Care Survey

Hospice Care - Data Highlights

 

Data Tables

 

Hospice Care Definitions of Terms

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).

 

 

 

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