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advanced care planning, end-of-life care, length of stay, long-term care, place of death, terminal hospital transfers



  1. Krishnan, Preetha BN, MN
  2. Williams, Heather RN
  3. Maharaj, Ian MD


Long-term-care (LTC) facilities or nursing homes have become a common site where older Canadians live and die. The proportion of deaths occurring in Canadian LTC facilities has been increasing in the past 2 decades and is expected to reach 40% by 2020. The aim of this retrospective cohort study was to identify individual characteristics of LTC residents associated with place of death (hospital vs LTC) and transfers to hospital in the 180 days preceding death. The sample consisted of all 118 residents who died between April 2010 and March 2013 in a 116-bed not-for-profit LTC facility in Winnipeg, Manitoba, Canada. Outcome measures were place of death and frequency of terminal hospital transfers. Predictor variables included demographics, social and clinical factors, and cause of death. Data were drawn from Minimum Data Set assessments, medical charts, and death certificates. The results showed that 19% of the 118 decedents were transferred to hospital in the last 6 months of life; 94% died in the LTC facility. Male gender, absence of eating problems, less cognitive impairment, and less functional dependency not only predicted in-hospital death but also increased the likelihood of terminal hospital transfers. Individual characteristics play a significant role in explaining the variation between place of death and rate of terminal hospital transfers among LTC residents. Comfort care orders strongly and independently decreased the rates of hospital death and terminal hospitalization.