Graduation Year


Document Type




Degree Granting Department

Aging Studies

Major Professor

William E. Haley, Ph.D.


End-of-life, Place of death, Race, Ethnicity, Health services utilization


This research investigated the racial/ethnic differences in hospice utilization and the effect of hospice in reducing the risk of hospital death at the end of life among non-Hispanic Black and non-Hispanic White dual-eligible (Medicare and Medicaid) older adults residing in a nursing home setting. The final study population included 30,765 non-Hispanic Black and non-Hispanic White nursing home residents who died between state fiscal years 2000-2002 in Florida.The behavioral model of health services use successfully predicted group membership in hospice use. In the full model, seven variables - female gender, non-Hispanic White race/ethnicity, being married, urban area of residence, and cancer and dementia/Alzheimer's disease as causes of death --

predicted increased likelihood of hospice use. This study also found that race/ethnicity moderates the strength of the effect of the illness on the likelihood of using hospice. Among residents who died of cancer, no difference in hospice use was found between the two racial/ethnic groups while hospice utilization rate among non-cancer residents was lower for non-Hispanic Blacks than non-Hispanic Whites.The same predisposing, enabling and need factors tested in predicting hospice use were examined for association with the probability of survival time since hospice admission. The poor model fit and the small number of factors found to significantly affect the probability of survival time from the initial hospice enrollment suggest that the survival time might be influenced by external factors other than covariates examined in this study.This study found hospice to be a powerful predictor of place of death among nursing home residents. After controlling for other factors, hospice nurs

ing home residents were 91 percent less likely to die in a hospital. At the same time, non-Hispanic Black residents were still 76 percent more likely to die in a hospital even after adjusting for the effect of hospice use and other variables.