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end-of-life care, hospice, innovations, nursing homes, profit status



  1. Davis, Jullet A. PhD


End-of-life service providers continue to seek improved instruments for individuals to convey their last wishes. Two such instruments are Five Wishes and Physician Order for Life-Sustaining Treatment. This project explores the relationship of nursing home profit status and innovativeness to the use of these advance directive programs (ADPs). The specific aims of this study were to determine what other types of innovations are associated with the use of these ADPs and the differences in use by nursing home characteristics. Data for this project come from the 2004 National Nursing Home Survey (n = 949). The data were analyzed using 3 logistic regression models. The results revealed that quality-of-life activities, having an in-house hospice, being a not-for-profit chain-affiliated nursing home, or a for-profit freestanding nursing home were all associated with ADP. These results suggest that ADP use may be influenced by nursing home characteristics other than clinical services.