Number 38 n April 27, 2011

Home Health Care and Discharged Hospice Care

Patients: United States, 2000 and 2007

by Christine Caffrey, Ph.D.; Manisha Sengupta, Ph.D.; Abigail Moss; Lauren Harris-Kojetin, Ph.D.; and

Roberto Valverde, M.P.H., Division of Health Care Statistics

Abstract

Objectives—This report presents national estimates on home health care

patients and discharged hospice care patients. Information on characteristics,

length of service, medical diagnoses, functional limitations, service use, advance

care planning, and emergent and hospital care use are presented for home health

care patients and hospice care discharges. A comparison of selected

characteristics for 2000 and 2007 is also provided to highlight changes.

Methods—Estimates are based on data collected on agencies from the 2000

and 2007 National Home and Hospice Care Survey, conducted by the Centers for

Disease Control and Prevention’s National Center for Health Statistics. Estimates

are derived from data collected during interviews with administrators and staff

designated by the administrators.

Results—Each day in 2007, there were an estimated 1,459,900 home health

care patients. They were predominantly aged 65 years or over, female, and white.

Their mean length of service was 315 days, and their most common primary

diagnosis at admission was diabetes mellitus. About one-fourth of them had

advance care planning and one-fifth had at least one overnight hospital stay since

admission to the home health care agency. In 2007, there were 1,045,100

discharged hospice care patients. The majority of discharged patients were aged

65 or over, female, and white, and most were discharged deceased. Their mean

length of service was 65 days, and the most common primary diagnosis at

admission was malignant neoplasm. Most of them had advance care planning,

and about one-fourth had three or more types of advance care planning

instruments.

Keywords: National Home and Hospice Care Survey • patient characteristics

• advance care planning • long-term care

Introduction

By 2050, an estimated 27 million

people will need some type of long-term

care (1). Of those 27 million, the

majority will receive long-term care in

the community. Home health and

hospice care agencies are major

providers of formal, community-based

long-term care. Currently, about 7.6

million people receive community-based

care to help with post-acute and chronic

conditions, disabilities, or terminal

illnesses (2). This number is expected to

increase as the population ages and the

desire to ‘‘age in place’’ continues (3–5).

Older Americans will increasingly

constitute a larger percentage of the

population in the future—from about

12% in 2006 to almost 20% in 2030 (6).

The majority of people using home

health and hospice care services are

over age 65 years (7). Most of them

have multiple chronic conditions, and

home health and hospice care services

enable many of them to receive services

in their homes and communities (4).

Home health care includes a range

of medical and therapeutic services as

well as other services delivered at a

patient’s home or in a residential setting

for promoting, maintaining, or restoring

health, or maximizing the level of

independence, while minimizing the

effects of disability and illness. Hospice

care emphasizes relieving pain and

uncomfortable symptoms of persons

with terminal illness and providing

emotional and spiritual support to both

the terminally ill and their family

members.

Despite the growth in home health

and hospice care, and the projected

increased demand for these services,

national data on long-term care

recipients are limited. This report

attempts to fill this gap by presenting

U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES 

Centers for Disease Control and Prevention 

National Center for Health Statistics 
Page 2	 National Health Statistics Reports n Number 38 n April 27, 2011

summary information on home health

care patients and discharged hospice

care patients. The figures and tables

present characteristics, length of service,

medical diagnoses, functional

limitations, service use, advance care

planning, and emergent and hospital

care use for both groups of patients.

Data from 2000 and prior years have

been published previously (7–10). This

report presents estimates from 2007 and

highlights changes between 2000 and

2007. Selected longer-term trends are

also presented.

Methods

The data in this report are from the

National Home and Hospice Care

Survey (NHHCS), which has been

conducted periodically since 1992 by

the Centers for Disease Control and

Prevention’s National Center for Health

Statistics. Most of the statistics in this

report are based on information

collected in 2000 and 2007 (7–10).

NHHCS is a national probability

sample survey that collects data on U.S.

home health and hospice care agencies,

their staff members, the services they

provide, and the people they serve.

Agencies that provided home health or

hospice care services at the time of the

survey were eligible to participate in

NHHCS. Up to 10 patients were

randomly selected per home health care,

hospice care, or mixed agency. Current

home health care patients were defined

as patients who were on the rolls of the

agency as of midnight of the day

immediately before the agency

interview. Discharged hospice care

patients were defined as patients who

were discharged from the hospice

agency during the 3-month period

beginning 4 months before the agency

interview.

The 2007 NHHCS represents a

redesign from previous NHHCS years,

including many new data items (such as

advance care planning and emergent

care), and collecting data using a

computer-assisted personal interviewing,

or CAPI, system. Nonetheless, all data

collection years of NHHCS share

important common features: cases in

NHHCS for each survey year were

associated with a sample weight,

whereby national estimates can be made

reflecting the composition of U.S. home

health and hospice care agencies in each

survey year; and many core data items

were collected in a consistent manner.

These core items include selected

patient characteristics and the receipt of

selected services; many of these are

presented in this report. For further

information on the sampling, survey

design, and other survey methodology,

see ‘‘Technical Notes’’ in this report and

the documentation for each survey year

available from: http://www.cdc.gov/nchs/

nhhcs.htm.

Data analysis

All analyses were performed in

SAS-callable SUDAAN (11) to account

for sampling weights and the complex

sampling design. Chi-square tests and

t tests were used to test for statistical

significance at the p < 0.05 level. No

adjustments were made for multiple

comparisons. Terms such as ‘‘similar’’

or ‘‘no significant differences’’ are used

to denote that the estimates being

compared are not significantly different

statistically. Comparisons not mentioned

may or may not be statistically

significant. A weighted least squares

technique was used (12) to test linear

trends across survey years. A downward

or upward trend is mentioned if it is

statistically significant. For length of

service changes between 2000 and 2007,

t tests were done for means and

medians.

Nonresponses (e.g., ‘‘don’t know’’

and ‘‘refused’’) for categorical variables

were recoded as unknown and included

in analyses. Among home health care

patients, the percentage of cases with

nonresponses ranged from 0.1% for

payment source in 2007 to 6.2% for

Hispanic or Latino origin in 2007.

Among discharged hospice care patients,

the percentage of cases with

nonresponses ranged from 0.1% for

certification status of the hospice care

provider in 2007 to 4.1% for Hispanic

or Latino origin in 2007. When 5% or

more of the responses are unknown, an

unknown category is included in the

tables. When an unknown category has

less than 5% nonresponse, the unknown

category is not reported in the tables.

Unknowns are included in the

denominators for percent distribution

estimates regardless of the percentage

unknown and whether they are reported

in the table. Except where noted, figures

depicting percentages also include the

unknown category in the denominator,

even when the unknown category itself

is not depicted in the figure. For this

reason, category-specific sample sizes

may sum to less than table or figure

totals, and percent distributions may

sum to less than 100%.

Unknowns were excluded for the

continuous variables: length of service,

total number of activities of daily living

(ADLs) limitations, number of ADLs

with which staff assist, and number of

advance care planning instruments.

Among home health care patients, the

percentage of cases with nonresponses

for length of service was 0.6% and for

number of advance care planning

instruments, 3.0%. Among discharged

hospice care patients, the percentage of

cases with nonresponses for length of

service was 0.2% and for number of

advance care planning instruments,

1.7%. See footnotes in tables and

figures for further detail on how

unknowns were handled.

Results

Home health care patients

Characteristics

+	 Each day in 2007, there were an

estimated 1,459,900 home health care

patients (Table 1). This is an increase

from 2000, when each day there were

1,355,300 home health care patients

(data not shown). A majority of home

health care patients lived with family

or nonfamily members (68.5%).

+	 Most home health care patients were

aged 65 or over (68.7%). About 6 out

of 10 (64.0%) home health care

patients were women. About 8 out of

10 (81.7%) patients were white.

+	 In 2007, more than one-half of all

patients (55.2%) received care

through proprietary agencies, 38.3%

through voluntary nonprofit agencies,

and the remaining 6.5% through
National Health Statistics Reports n Number 38 n April 27, 2011	 Page 3

government or other agencies. From

2000 through 2007, there was an

increase in the percentage of patients

receiving care through proprietary

agencies (34.1% in 2000 and 55.2%

in 2007) and a related decrease in the

percentage receiving care through

voluntary nonprofit agencies (56.6%

in 2000 and 38.3% in 2007); there

was no difference in government or

other agencies (data not shown).

Length of service

+ During 2007, the mean length of

service for home health care patients

was 315 days, with a median of 70

days (Table 2).

+ Mean length of service was longer

for patients who were under age 65

(474 days) than for those 65 and over

(242 days). Among patients younger

than age 65, mean length of service

was longer for patients who were

younger than age 45 (692 days) than

for those aged 45–64 (326 days).

+ Among the oldest-old patients (aged

85 and over), mean length of service

decreased from 419 days in 2000 to

270 days in 2007; median length of

service decreased from 155 days in

2000 to 91 days in 2007 (Figure 1).

+ On average, patients receiving care

from proprietary agencies had a

longer mean period of service (374

days) than patients receiving care

from voluntary nonprofit agencies

(203 days).

Medical diagnoses

Primary diagnosis at admission

+	 In 2007, the most common primary

diagnoses at admission among home

health care patients were diabetes

mellitus (10.1%); heart disease

(8.8%), including congestive heart

failure (4.3%); malignant neoplasm

(3.9%); chronic obstructive

pulmonary diseases and allied

conditions (3.4%); essential

hypertension (3.3%); and

cerebrovascular disease (3.3%)

(Table 3).

+	 Among home health care patients,

10.1% had as their primary diagnosis

a condition coded within the major

disease category of symptoms, signs,

and ill-defined conditions; among

these, the most common was

abnormality of gait due to symptoms

involving the nervous or

musculoskeletal systems (4.3%) (data

not shown).

+	 Another 10.4% of home health care

patients had as their primary

diagnosis a condition coded within

the supplementary classification used

for posthospital aftercare; among

these, the most common was

orthopedic aftercare (4.7%) (data not

shown).

0 

100 

200 

300 

400 

500 

Median 

Mean 

2000 2007 

419 

days 

Days 

155 

days 

91 

days 

270 

days 

NOTES: Percentages are based on unrounded numbers. Denominator does not include unknowns. 

SOURCE: CDC/NCHS, National Home and Hospice Care Survey, 2000 and 2007. 

Figure 1. Length of service for home health care patients aged 85 and over: United States,

2000 and 2007

All-listed diagnoses at interview

+	 Among all-listed diagnoses at the

time of interview, 41.1% of patients

had essential hypertension, 31.3% had

heart disease, 30.6% had diabetes

mellitus, 13.5% had chronic

obstructive pulmonary diseases and

allied conditions, 10.0% had

osteoarthritis (except spine), 8.6%

had a malignant neoplasm, 7.1% had

dementia, and 7.1% had

cerebrovascular disease (Figure 2).

+	 Home health care patients had an

average of 4.2 diagnoses per patient

at the time of interview (data not

shown).

Limitations in activities of daily

living

+	 Five ADLs—bathing, dressing,

transferring, using the toilet room,

and eating—that reflect the home

health care patient’s capacity for

self-care at interview were included

in this report.

+	 In 2007, 84.0% of home health care

patients had at least one ADL

limitation and 14.8% had no ADL

limitations (data not shown). Among

home health care patients with at

least one ADL limitation, 50.5% had

four to five limitations, 21.7% had

three limitations, 16.5% had two

limitations, and 11.3% had one

limitation. Among home health care

patients with at least one ADL

limitation, a larger percentage of

those living with others (54.7%) had

four to five limitations compared with

those living alone (39.4%) (Figure 3).

+	 In 2007, among home health care

patients with at least one ADL

limitation, 48.0% were receiving no

help with their limitation from home

health care agency staff. Among

home health care patients with at

least one ADL limitation, those living

with others were more likely to

receive no ADL assistance from

agency staff compared with patients

living alone (51.0% compared with

40.6%).
50 

Essential Heart Diabetes Chronic Osteoarthritis Malignant Dementia Cerebrovascular

41.1 

31.3 30.6 

13.5 

10.0 8.6 7.1 7.1 

Percent 

40 

30 

20 

10 

0 

hypertension disease mellitus obstructive and allied neoplasm 

pulmonary disorders, 

disease and except spine 

allied conditions 

disease 

NOTES: Percentages are based on unrounded numbers. Denominator includes unknowns. 

SOURCE: CDC/NCHS, National Home and Hospice Care Survey, 2007. 

0 

20 

80 

100 

Number of ADLs1

, by living arrangement, 2007 Number of ADLs1 requiring staff help, by living arrangement, 2007 

100 

Percent 

50.5 

39.4 

54.7 

22.4 

14.3 

8.6 

19.8 

22.4 

18.5 

21.7 

16.5 

11.3 One 

Two 

Three 

Four or five 

19.9 

9.8 

11.4 

10.8 

48.0 

17.7 

10.0 

14.7 

16.9 

40.6 

20.7 

9.7 

10.0 

8.6 

51.0 

One 

None 

Two 

Three 

Four or five 

80 

60 

40 

20 

60 

40

Percent

0 All Living Living All Living Living 

patients alone with others patients alone with others 

1 Activities of daily living. 

NOTES: The denominator for all data is current home health care patients who had at least one ADL limitation at interview (84.0%). Percentages may not add to 100% due to rounding. 

Percentages are based on unrounded numbers. Denominator does not include unknowns. 

SOURCE: CDC/NCHS, National Home and Hospice Care Survey, 2007. 

Page 4	 National Health Statistics Reports n Number 38 n April 27, 2011

Figure 2. Selected chronic conditions of home health care patients at interview: United States, 2007

Figure 3. Home health care patients with at least one limitation in activities of daily living, by living arrangement: United States, 2007

Advance care planning

+ During 2007, patients under age 45

had a significantly lower likelihood

of having advance care planning at

interview than older patients (12.0%

compared with 21.2% of those aged

45–64 and 33.6% aged 65 or over)

(Table 4, Figure 4).

+	 White home health care patients were

about 21⁄2 times as likely to have

advance care planning as black home

health care patients (32.0% compared

with 12.5%).

+	 Living wills (16.8%) and durable

power of attorney (13.7%) were the

two most common types of advance

care planning instruments reported for

home health care patients; about 8%

(data not shown) of home health care

patients had both a living will and a

durable power of attorney.

Emergent care and hospital use

+	 More than one-tenth (12.7%) of home

health care patients had at least one

emergent care service in the 60 days

before the agency interview

(Figure 5). Of these patients, 87.4%
National Health Statistics Reports n Number 38 n April 27, 2011	 Page 5

0 

10 

20 

30 

40 

50 

65–74 75–84 85+ Black White

Age at interview Race 

All home health Under 45 45–64

care patients 

Percent

28.6 

12.0 

21.2 

23.9 

33.6 

41.6 

12.5 

32.0 

NOTES: Percentages are based on unrounded numbers. Denominator includes unknowns. 

SOURCE: CDC/NCHS, National Home and Hospice Care Survey, 2007. 

Figure 4. Home health care patients with advance care planning at interview, by age and race: United States, 2007

0 

20 

40 

60 

80 

100 Yes No

Had at least one overnight

hospital stay since agency admission

Had at least one emergent

care service in past 60 days 

12.7 

86.4 

21.4 

77.3 

Percent 

NOTES: Emergent care services Include hospital emergency room visits (including 23-hour holding), doctors' office 

emergency visits or house calls, and outpatient department or clinic visits (including urgent care center sites). 

Percentages may not add to 100% because of rounding and inclusion of unknowns in percent distribution. Percentages 

are based on unrounded numbers. 

SOURCE: CDC/NCHS, National Home and Hospice Care Survey, 2007. 

Figure 5. Use of emergent care services and overnight hospital stays for home health

care patients: United States, 2007

visited a hospital emergency room

(data not shown).

+ More than one-fifth (21.4%) of home

health care patients had at least one

overnight hospital stay since

admission to the home health care

agency.

Discharged hospice care

patients

Characteristics

+	 During 2007, there were 1,045,100

patients discharged from hospice care,

a 68% increase since 2000 when

there were 621,000 patients

discharged from hospice care (data

not shown for 2000). The most

common reason for discharge was

death (84.3%); the remaining 15.6%

were discharged because their

condition had stabilized and they no

longer needed services, or because

they were transferred to an inpatient

care or another hospice care facility

(Table 5).

+	 The majority of discharged hospice

care patients were aged 65 and over

(83.1%). Discharged patients were

predominantly white (90.7%) and not

of Hispanic or Latino origin (91.9%).

In 2007, there were more women

(55.1%) among discharged hospice

care patients than men (44.9%)—a

change from 2000, when there was

no significant difference by sex (data

not shown for 2000).

+	 Most of the discharged patients

received services from a voluntary

nonprofit agency (66.7%), and

another 31.2% received care from

proprietary agencies. Although the

relative number of discharged patients

receiving services in proprietary

agencies increased in 2007 from

2000, the percentage receiving

services in proprietary agencies

almost doubled, from 15.8% in 2000

to 31.2% in 2007; a related decrease

was evident among those receiving

services through voluntary agencies

(80.0% in 2000 and 66.7% in 2007)

(Figure 6). In 2007, about one-quarter

(27.2%) of discharged patients
Page 6	 National Health Statistics Reports n Number 38 n April 27, 2011

was also longer for females (75 days)

than males (53 days).

+ The mean length of service was

significantly longer for those

0 

20 

40 

60 

80 

100 

Percent 

2000 2007

15.8 

31.2 

80.0 

66.7 

4.2 †

2.2 

41.5 

27.2 

58.5 

72.8 

Proprietary Voluntary Government Chain Not chain 

nonprofit or other affiliated affiliated 

Ownership Chain affiliation 

†

Estimate does not meet standards of reliability or precision because the sample size is between 30 and 59, or the sample 

size is greater than 59 but has a relative standard error of 30 percent or more. 

NOTES: Percentages may not add to 100% because of rounding and inclusion of unknowns in percent distribution. 

Percentages are based on unrounded numbers. 

SOURCE: CDC/NCHS, National Home and Hospice Care Survey, 2000 and 2007. 

discharged alive (138 days) than for

those who were deceased at discharge

(52 days).

+ The mean length of service was

longer in proprietary agencies (83

days) than in government or other

agencies (60 days) and voluntary

nonprofits (57 days). Mean length of

service was also longer for discharged

patients receiving care from chainaffiliated agencies (83 days)

compared with nonchain-affiliated

agencies (59 days).

Medical diagnoses

Figure 6. Discharged hospice care patients, by selected agency characteristics:

Primary diagnosis at admission

+ The most common primary admission

United States, 2000 and 2007	 diagnosis among discharged hospice

care patients in 2007 was malignant

neoplasm (42.8%) (Table 7). The

most common noncancer primary

1992 1994 1996 1998 2000 2007 

0 

20 

40 

60 

80 

Percent 

NOTES: Percentages are based on unrounded numbers. Denominator includes unknowns. 

SOURCE: CDC/NCHS, National Home and Hospice Care Survey, 1992, 1994, 1996, 1998, 2000, and 2007. 

All other diagnoses 

Malignant neoplasms 

74.7 

69.0 69.7 

64.8 

57.5 

42.8 

57.2 

42.5 

35.2 

31.0 30.3

25.3 

admission diagnoses were heart

disease (11.1%), including congestive

heart failure (6.4%); dementia (6.6%,

data not shown); chronic obstructive

pulmonary disease and allied

conditions (4.7%); and

cerebrovascular disease (4.5%).

+	 Hospice care patients are no longer

predominantly cancer patients. In

recent years, hospice care has come

to be used increasingly by persons

with primary diagnoses other than

cancer. Data from NHHCS reflect this

trend (Figure 7). The numbers of

discharged hospice care patients with

a primary diagnosis of malignant

neoplasm at admission increased from

1992 (163,800) (data not shown)

through 2007 (447,600). However,

the percentage of discharged hospice

care patients with this diagnosis at

admission steadily declined, from

74.7% in 1992 when NHHCS started

monitoring it to 42.8% in 2007. The

percentage of discharged patients with

noncancerous primary diagnoses has

increased from 25.3% in 2000 to

57.2% in 2007.

All-listed diagnoses at discharge

+	 Discharged hospice care patients had

an average of 3.3 diagnoses at time

of discharge (data not shown).

Figure 7. Discharged hospice care patients, by primary admission diagnosis:

United States, selected years, 1992–2007

received care from chain-affiliated

agencies, a decrease from 2000 when

41.5% of discharged patients received

services from chain affiliates.

Length of service

+ During 2007, only 37% of discharged

hospice care patients received care

for at least 30 days (data not shown),

which is considered to be the most

effective length of stay for hospice

care (13,14). The mean length of

service for discharged hospice care

patients was 65 days; the median

length of service was 16 days

(Table 6).

+	 Mean length of service varied by age:

The average length of service

increased with age and was longest

for discharged patients who were

aged 75–84 (68 days) and 85 or over

(80 days). The mean length of service
100 

80 

60 

40 

20 

0 

Skilled Bereave- Medical 

nursing ment* social 

Core services Noncore services 97.8 

83.6 82.1 79.9 

53.5 

31.3 

21.5 

79.5 

17.7 

9.8 9.3 

4.2 

Percent 

Pastoral Physician Dietary* 

or 

Volunteer Personal 

care* 

spiritual* 

*Services provided to hospice discharge patient, family members, or friends. 

**Includes physical, occupational, and speech/audiology therapies. 

NOTES: Percentages are based on unrounded numbers. Denominator includes unknowns. 

SOURCE: CDC/NCHS, National Home and Hospice Care Survey, 2007. 

Homemaker Continuous 

home 

Respite* Therapeutic** 

care 

National Health Statistics Reports n Number 38 n April 27, 2011	 Page 7

Figure 8. Service use involving discharged hospice care patients: United States, 2007

+ Among all-listed diagnoses at time of

discharge among hospice care patients

in 2007, the most common diagnosis

was malignant neoplasm (46.4%).

Other all-listed diagnoses at time of

discharge in 2007 were heart disease

(32.2%), including congestive heart

failure (15.4%); essential

hypertension (23.5%); dementia

(21.3%), (data not shown), (see

‘‘Technical Notes’’ for definition);

chronic obstructive pulmonary disease

and allied conditions (14.8%);

diabetes mellitus (12.2%); and

cerebrovascular disease (10.9%)

(Table 7).

+ In addition, 20.7% of discharged

hospice care patients had a diagnosis

coded in the major disease category

of symptoms, signs, and ill-defined

conditions; of these, 5.2% were adult

failure to thrive and 6.4% had an

unspecified debility (excluding

asthenia) (data not shown).

Service use

+ Among core services (see ‘‘Technical

Notes’’ for definition), almost all

discharged hospice care patients in

2007 received skilled nursing services

(97.8%), up from 91.8% in 2000

(Figure 8, data not shown for 2000).

In 2007, 83.6% received bereavement

services, 82.1% received medical

social services, 79.9% received

pastoral or spiritual services, more

than one-half (53.5%) received

physician services, about one-third

(31.3%) received dietary services, and

more than one-fifth (21.5%) received

volunteer services. Discharged

hospice care patients in agencies that

were part of a chain were more likely

to receive physician services (63.3%)

than discharged hospice care patients

in agencies that were not part of a

chain (49.8%) (data not shown).

+	 Among noncore services (see

‘‘Technical Notes’’ for definition),

almost 8 out of 10 (79.5%)

discharged hospice care patients

received personal care, that is,

assistance with ADLs. In 2007,

17.7% of discharged hospice care

patients received homemaker services,

up from 12.6% in 2000 (data not

shown). About one-tenth (9.8%)

received continuous home care, 9.3%

received respite services, and 4.2%

received therapeutic services.

+	 Just over one-third (35.1%) of

discharged hospice care patients

received formal care services in 2007

(see ‘‘Technical Notes’’ for definition)

(data not shown). Patients discharged

deceased (37.5%) were more likely to

have received formal care than those

discharged alive (22.6%) (data not

shown).

Advance care planning

Regardless of age, in 2007 the vast

majority of discharged hospice care

patients had advance care planning,

from 75.8% of those under age 45 (data

not shown) to 93.1% of those aged 85

and over (Table 8).

+	 Over one-fourth (26.9%) of all

discharged hospice care patients had

three or more types of advance care

planning instruments.

+	 White discharged hospice care

patients were more likely to have

advance care planning (89.4%) than

those who were either black (79.5%)

or of some other race (75.5%).

+	 The most common type of advance

care planning instrument among

discharged hospice care patients was

a do-not-resuscitate order (80.2%),

followed by a durable power of

attorney (36.4%) and a living will

(25.3%) (Table 8, Figure 9).

Emergent care use

+	 More than 5% of discharged hospice

care patients (6.3%) had at least one

emergent care service while receiving

care from the hospice care

organization (data not shown).
Page 8	 National Health Statistics Reports n Number 38 n April 27, 2011

0 20 40 60 

Percent 

80 100 

No advance 

care planning 

Do not resuscitate 

Power of attorney 

Living will 

Health care proxy 

Comfort measures 

Do not hospitalize 

Feeding restriction 

Medication restriction 

NOTES: Percentages are based on unrounded numbers. Denominator includes unknowns. 

SOURCE: CDC/NCHS, National Home and Hospice Care Survey, 2007. 

2.1 

4.9 

6.2 

11.5 

15.9 

25.3 

36.4 

80.2 

11.6 

Figure 9. Discharged hospice care patients with advance care planning: United States,

2007

+ Hospice care patients discharged alive

were almost four times as likely

(16.9%) as those discharged deceased

(4.3%) to have had an emergent care

service while in hospice care (data

not shown).

References

1.	 Department of Health and Human

Services and Department of Labor.

The future supply of long-term care

workers in relation to the aging baby

boom generation: Report to

Congress. Washington, DC. 2003.

2.	 National Association for Home Care

& Hospice. Basic statistics about

home care. Washington, DC. 2008.

Available from: http://www.nahc.org/

facts/08HC_Stats.pdf.

3.	 Medicare Payment Advisory

Committee. Report to the Congress:

Reforming the delivery system. 2008.

Available from: http://www.medpac.

gov/documents/Jun08_Entire

Report.pdf.

4.	 Kirby JB, Lau DT. Community and

individual race/ethnicity and home

health care use among elderly

persons in the United States. Health

Serv Res 45(5 Pt1):1251–67. 2010.

5.	 Hospice Association of America.

Hospice facts and statistics. 2008.

Available from: http://www.nahc.org/

facts/HospiceStats08.pdf.

6.	 U.S. Census Bureau. The older

population in the United States: 2010

to 2050. Available from: http://

www.census.gov/prod/2010pubs/p25­

1138.pdf.

7.	 2000 National Home Health and

Hospice Care Survey. Data

highlights—Selected tables and charts.

Available from: http://www.cdc.gov/

nchs/nhhcs/nhhcs_products.htm.

8.	 Dwyer LL, Harris-Kojetin L,

Branden L, Shimizu IM. Redesign

and operation of the National Home

and Hospice Care Survey, 2007.

National Center for Health Statistics.

Vital Health Stat 1(53). 2010.

9.	 National Center for Health Statistics.

2000 National Home and Hospice

Care Survey. Scope of survey. 2000.

Available from: http://www.cdc.gov/

nchs/nhhcs/nhhcs_scope.

htm#00scope.

10. National Center for Health Statistics.

2007 National Home and Hospice

Care Survey. Survey documentation.

2007. Available from: http://www.

cdc.gov/nchs/data/nhhcsd/NHHCS_

NHHAS_web_documentation.pdf.

11. Research Triangle Institute.

SUDAAN (Release 9.0.1). Research

Triangle Park, NC. 2005.

12. Sirken MG, Shimizu BI, French DK,

et al. Manual on standards and

procedures for reviewing statistical

reports. Hyattsville, MD: National

Center for Health Statistics. 1992.

13. Haupt BJ. Characteristics of hospice

care discharges and their length of

service: United States, 2000. National

Center for Health Statistics. Vital

Health Stat 13(154). 2003.

14. Miller SC, Gozalo P, Mor V.

Outcomes and utilization for hospice

and non-hospice nursing facility

decedents. Washington, DC: U.S.

Department of Health and Human

Services, Office of Disability, Aging,

and Long-Term Care Policy. 2000.

15. Haupt BJ, Jones A. National Home

and Hospice Care Survey: Annual

summary, 1996. National Center for

Health Statistics. Vital Health Stat

13(141). 1999.

16. U.S. Office of Management and

Budget. 1997 standards for the

classification of federal data on race

and ethnicity. Available from:

http://www.whitehouse.gov/omb/

fedreg_1997standards.

17. National Center for Chronic Disease

Prevention and Health Promotion.

The power of prevention: Chronic

disease . . . the public health

challenge of the 21st century. 2009.

Available from: http://www.cdc.gov/

chronicdisease/pdf/2009-Power-ofPrevention.pdf.

18. National Center for Health Statistics,

Centers for Medicare and Medicaid

Services. International classification

of diseases, 9th revision, clinical

modification. Available from:

http://www.cdc.gov/nchs/icd/

icd9cm.htm.

19. U.S. Government Printing Office.

Code of federal regulations

42CFR418.50–100. 2002. Available

from: http://www.gpoaccess.gov/cfr/

index.html.
National Health Statistics Reports n Number 38 n April 27, 2011 Page 9

Table 1. Selected characteristics of home health care patients: United States, 2007

(Standard Percent (Standard

Characteristic Number error) distribution error)

Total. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1,459,900 (65,902) 100.0 . . .

Age1

Under 65 years ............................. 456,600 (33,009) 31.3 (1.7)

Under 18 years ........................... 67,200 (12,640) 4.6 (0.8)

18–44 years ............................. 118,100 (14,513) 8.1 (0.9)

45–64 years ............................. 271,300 (20,777) 18.6 (1.1)

65 years and over ........................... 1,003,400 (51,733) 68.7 (1.7)

65–69 years ............................. 120,500 (11,112) 8.3 (0.6)

70–74 years ............................. 140,600 (13,073) 9.6 (0.8)

75–79 years ............................. 204,100 (16,054) 14.0 (0.8)

80–84 years ............................. 220,400 (16,946) 15.1 (0.9)

85–89 years ............................. 195,500 (14,239) 13.4 (0.8)

90–94 years ............................. 94,700 (8,309) 6.5 (0.5)

95 years and over.......................... 27,600 (5,158) 1.9 (0.3)

Sex

Male ................................... 525,200 (28,317) 36.0 (1.4)

Female .................................. 934,700 (49,421) 64.0 (1.4)

Hispanic or Latino origin

Hispanic or Latino ........................... 111,900 (15,041) 7.7 (1.0)

Not Hispanic or Latino ........................ 1,257,100 (64,087) 86.1 (1.7)

Unknown................................. 90,900 (20,215) 6.2 (1.4)

Race

White ................................... 1,192,100 (58,936) 81.7 (1.7)

Black ................................... 230,400 (27,679) 15.8 (1.7)

Other2 ................ ................ 37,400 (8,017) 2.6 (0.5)

Living arrangements

Living alone ............................... 441,900 (30,473) 30.3 (1.5)

Living with others. . . . . . . . . . . . . . . . . . . . . . . . . . . . 999,900 (49,178) 68.5 (1.5)

Ownership

Proprietary................................ 806,500 (60,973) 55.2 (3.5)

Voluntary nonprofit ........................... 558,600 (58,041) 38.3 (3.4)

Government and other ........................ 94,900 (21,408) 6.5 (1.5)

Chain affiliation

Part of a chain ............................. 408,600 (46,915) 28.0 (3.1)

Not part of a chain ........................... 1,051,300 (69,885) 72.0 (3.1)

Certification

Medicare and Medicaid ........................ 1,154,800 (70,446) 79.1 (2.9)

Medicare ................................. 142,500 (29,934) 9.8 (2.1)

Medicaid ................................. 117,000 (33,239) 8.0 (2.2)

Not certified3 .............. .............. †29,300 (12,047) †2.0 (0.8)

Geographic region

Northeast ................................ 267,000 (35,188) 18.3 (2.4)

Midwest ................................. 354,500 (55,799) 24.3 (3.4)

South ................................... 634,500 (60,928) 43.5 (3.6)

West ................................... 204,000 (30,779) 14.0 (2.2)

Location of agency

Metropolitan statistical area4 ..................... 1,199,100 (64,182) 82.1 (1.2)

Micropolitan statistical area5 ..................... 157,500 (12,007) 10.8 (0.9)

Neither .................................. 103,300 (10,632) 7.1 (0.7)

. . . Category not applicable.

† Estimate does not meet standards of reliability or precision because the sample size is between 30 and 59, or the sample size is greater than 59 but has a relative standard error of 30% or

more. 1

Patient’s age at time of survey. 2

Includes Asian, Native Hawaiian or Other Pacific Islander, American Indian or Alaska Native, and multiple races. All race categories include persons of Hispanic and non-Hispanic origin. Persons 

of Hispanic origin may be of any race. 3

Includes agencies pending certification. 4

A county or group of contiguous counties that contains at least one urbanized area of 50,000 or more population. The area may also contain other counties that are economically and socially

integrated with the central county, as measured by commuting. 5

A nonmetropolitan county or group of contiguous nonmetropolitan counties that contains an urban cluster of 10,000–49,999 persons. The area may include surrounding counties if strong

economic ties exist between the counties, based on commuting patterns.

NOTE: Numbers may not add to totals, and percent distributions may not add to 100%, because of rounding and because the denominators for percent distributions may include a category of

unknowns not reported in the table.

DATA SOURCE: CDC/NCHS, National Home and Hospice Care Survey, 2007.
Page 10 National Health Statistics Reports n Number 38 n April 27, 2011

Table 2. Length of service (in days) for home health care patients, by selected characteristics: United States, 2007

Percent (Standard (Standard

Characteristic Number distribution Mean error) Median error)

Total. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1,459,900 100.0 315 (33.1) 70 (8.2)

Age1

Under 65 years ............................. 456,600 31.3 474 (83.6) 83 (16.3)

Under 45 years ........................... 185,300 12.7 692 (175.4) †129 (69.7)

45–64 years ............................. 271,300 18.6 326 (43.5) 55 (11.8)

65 years and over ........................... 1,003,400 68.7 242 (21.1) 64 (7.2)

65–74 years ............................. 261,100 17.9 256 (45.3) 69 (10.0)

75–84 years ............................. 424,500 29.1 213 (20.1) 50 (5.3)

85 years and over.......................... 317,800 21.8 270 (25.6) 91 (12.3)

Sex

Male ................................... 525,200 36.0 343 (56.0) 78 (9.8)

Female .................................. 934,700 64.0 299 (27.9) 64 (8.7)

Hispanic or Latino origin

Hispanic or Latino ........................... 111,900 7.7 329 (61.3) 90 (26.2)

Not Hispanic or Latino......................... 1,257,100 86.1 319 (36.5) 70 (8.3)

Unknown................................. 90,900 6.2 238 (55.8) †51 (19.4)

Race

White ................................... 1,192,100 81.7 308 (36.7) 63 (7.6)

Black ................................... 230,400 15.8 333 (48.4) 100 (22.0)

Other2 ................ ................ 37,400 2.6 423 (98.5) †134 (47.4)

Living arangements

Living alone ............................... 441,900 30.3 317 (32.8) 91 (15.4)

Living with others. . . . . . . . . . . . . . . . . . . . . . . . . . . . 999,900 68.5 316 (42.5) 63 (6.4)

Primary source of payment3

Private4................. ................. 198,400 13.6 216 (34.1) 43 (6.4)

Medicare ................................. 825,400 56.5 166 (12.8) 50 (3.4)

Medicaid ................................. 318,800 21.8 714 (107.3) 321 (76.5)

All other sources5 ........................... 61,700 4.2 625 (109.6) 214 (61.0)

Ownership

Proprietary................................ 806,500 55.2 374 (56.5) 94 (15.2)

Voluntary nonprofit ........................... 558,600 38.3 203 (17.8) 44 (3.8)

Government or other ......................... 94,900 6.5 468 (89.6) †159 (52.6)

Chain affiliation

Part of a chain ............................. 408,600 28.0 335 (56.9) 64 (11.7)

Not part of a chain ........................... 1,051,300 72.0 307 (40.4) 74 (9.6)

Certification

Medicare and Medicaid ........................ 1,154,800 79.1 247 (19.2) 59 (6.3)

Medicare ............................... 142,500 9.8 117 (21.3) 45 (7.5)

Medicaid. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 117,000 8.0 1,050 (274.9) †468 (247.4)

Not certified6 .............................. †29,300 †2.0 715 (186.1) 425 (90.7)

Geographic region

Northeast ................................ 267,000 18.3 495 (134.5) 83 (22.5)

Midwest ................................. 354,500 24.3 253 (43.1) 51 (10.1)

South ................................... 634,500 43.5 289 (35.7) 88 (13.8)

West ................................... 204,000 14.0 269 (50.0) 53 (13.2)

Location of agency

Metropolitan statistical area7 ..................... 1,199,100 82.1 309 (39.8) 63 (8.6)

Micropolitan statistical area8 ..................... 157,500 10.8 324 (34.8) 105 (14.4)

Neither .................................. 103,300 7.1 373 (42.5) 124 (22.5)

† Estimate does not meet standards of reliability or precision because the sample size is between 30 and 59, or the sample size is greater than 59 but has a relative standard error of 30% or

more. 1

Patient’s age at time of survey. 2

Includes Asian, Native Hawaiian or Other Pacific Islander, American Indian or Alaska Native, and multiple races. All race categories include persons of Hispanic and non-Hispanic origin. Persons 

of Hispanic origin may be of any race. 3

At time of interview. 4

Includes private health insurance, long-term care insurance, and self-pay by patient or family. 5

Includes Tricare, Department of Veteran Affairs, ChampVA, worker’s compensation, other government, no charge for care, other source, and payment source not yet determined. 6

Includes agencies pending certification. 
National Health Statistics Reports n Number 38 n April 27, 2011 Page 11

7

A county or group of contiguous counties that contains at least one urbanized area of 50,000 or more population. The area may also contain other counties that are economically and socially 

integrated with the central county, as measured by commuting. 8

A nonmetropolitan county or group of contiguous nonmetropolitan counties that contains an urban cluster of 10,000–49,999 persons. The area may include surrounding counties if there are strong 

economic ties between the counties, based on commuting patterns. 

NOTES: Numbers may not add to totals, and percent distributions may not add to 100%, because of rounding and because the denominators for percent distributions may include a category of 

unknowns not reported in the table. For length of service, six unknowns are excluded from the mean and median calculations. 

DATA SOURCE: CDC/NCHS, National Home and Hospice Care Survey, 2007. 
Page 12 National Health Statistics Reports n Number 38 n April 27, 2011 

ses for home health care patients: United States, 2007Primary diagnoses2 All-listed diagnoses3 At admission At interview At interview (Standard Percent (Standard (Standard Percent (Standard (Standard (Standard 

de1 Number error) distribution error) Number error) distribution error) Number error) Percent error) 

. . . . . . . . . . . . 1,459,900 (65,902) 100.0 . . . 1,459,900 (65,902) 100.0 . . . . . . . . . . . . . . . 

. . . . . .(001–139) †12,400 (4,194) †0.8 (0.3) †12,000 (4,189) †0.8 (0.3) 46,500 (7,651) 3.2 (0.5) 

. . . . . .(140–239) 59,600 (7,348) 4.1 (0.5) 59,200 (7,367) 4.1 (0.5) 128,800 (12,081) 8.8 (0.7) 

(140–208,230–234) 57,400 (7,316) 3.9 (0.5) 58,000 (7,320) 4.0 (0.5) 124,800 (11,981) 8.6 (0.7) 

s and immunity 

. . . . . .(240–279) 166,762 (17,031) 11.4 (1.1) 184,500 (17,892) 12.6 (1.1) 583,000 (35,195) 39.9 (1.6) 

. . . . . . . . .(250) 146,800 (16,446) 10.1 (1.0) 164,300 (17,211) 11.3 (1.1) 447,200 (29,440) 30.6 (1.4) 

ans . . . .(280–289) 20,000 (3,526) 1.4 (0.2) 25,800 (4,175) 1.8 (0.3) 132,700 (13,505) 9.1 (0.8) 

. . . . . .(280–285) 19,500 (3,519) 1.3 (0.2) 25,300 (4,169) 1.7 (0.3) 122,200 (12,604) 8.4 (0.8) 

. . . . . .(290–319) 55,200 (11,170) 3.8 (0.7) 62,600 (11,745) 4.3 (0.8) 284,800 (22,370) 19.5 (1.3) 

. . . . . .(290,310) * * * * * * * * †9,300 (2,427) †0.6 (0.2) 

. . . . . .(317–319) * * * * * * * * 32,300 (7,119) 2.2 (0.5) 

(291–309,311–316) 46,600 (10,638) 3.2 (0.7) 51,800 (11,217) 3.5 (0.7) 257,500 (20,946) 17.6 (1.2) 

rgans. . .(320–389) 122,600 (13,858) 8.4 (0.9) 109,300 (11,173) 7.5 (0.7) 328,400 (24,050) 22.5 (1.4) 

. . . . . . . .(331.0) †14,200 (3,494) †1.0 (0.2) †11,900 (3,327) †0.8 (0.2) 37,400 (6,024) 2.6 (0.4) 

. . . . . . . . .(332) †18,900 (4,437) †1.3 (0.3) †20,100 (4,726) †1.4 (0.3) 38,400 (5,902) 2.6 (0.4) 

. . . . . . . . .(340) 20,900 (4,316) 1.4 (0.3) 20,100 (4,153) 1.4 (0.3) 27,800 (4,697) 1.9 (0.3) 

. . . . . .(342–344) 35,100 (6,677) 2.4 (0.4) 27,900 (5,132) 1.9 (0.4) 69,700 (10,632) 4.8 (0.7) 

nd sense 

–337,341,345–389) 33,400 (6,428) 2.3 (0.4) 29,400 (5,308) 2.0 (0.4) 181,900 (18,019) 12.5 (1.1) 

. . . . . .(390–459) 267,300 (21,850) 18.3 (1.0) 275,700 (22,160) 18.9 (1.1) 918,900 (50,013) 62.9 (1.6) 

. . . . . . . . .(401) 48,800 (8,384) 3.3 (0.5) 56,500 (8,753) 3.9 (0.5) 600,100 (37,085) 41.1 (1.7) 

0,393–398,402,404, 410–416,420–429) 129,100 (14,137) 8.8 (0.8) 135,700 (14,452) 9.3 (0.8) 457,700 (29,308) 31.3 (1.3) 

. . . . . . . . .(414) * * * * * * * * 31,700 (6,132) 2.2 (0.4) 

.(412,414.1–414.9) 21,000 (4,346) 1.4 (0.3) †18,900 (4,164) †1.3 (0.3) 115,600 (13,447) 7.9 (0.9) 

. . . . . . . . .(427) 27,200 (6,295) 1.9 (0.4) 34,700 (6,851) 2.4 (0.5) 145,100 (14,559) 9.9 (0.9) 

. . . . . . . .(428.0) 62,500 (9,257) 4.3 (0.6) 59,800 (9,033) 4.1 (0.6) 208,400 (17,529) 14.3 (0.9) 

,393–398,415–416, 

20–426,428.1–429) †13,300 (3,172) †0.9 (0.2) †13,100 (3,205) †0.9 (0.2) 69,100 (7,478) 4.7 (0.5) 

430–435, 437–438) 48,600 (6,449) 3.3 (0.4) 44,800 (6,415) 3.1 (0.4) 103,200 (11,028) 7.1 (0.7) 

3,405,417,440–459) 40,800 (7,726) 2.8 (0.5) 38,700 (7,501) 2.7 (0.5) 154,200 (15,243) 10.6 (0.9) 

. . . . . .(460–519) 79,600 (9,625) 5.5 (0.6) 76,300 (9,124) 5.2 (0.6) 252,400 (18,596) 17.3 (1.0) 

. . . . . .(480–486) 22,200 (6,049) 1.5 (0.4) †14,300 (4,765) †1.0 (0.3) 30,300 (6,693) 2.1 (0.4) 

allied 

. . . . . .(490–491) 49,600 (7,224) 3.4 (0.5) 52,300 (7,254) 3.6 (0.5) 196,900 (2,542) 13.5 (0.2) 

–478,487,500–519) †7,900 (2,620) †0.5 (0.2) †9,800 (3,205) †0.7 (0.2) 44,700 (6,557) 3.1 (0.4) 

. . . . . .(520–579) 31,800 (5,180) 2.2 (0.3) 27,800 (4,862) 1.9 (0.3) 161,900 (12,988) 11.1 (0.9) 

. . . . . .(580–629) 32,700 (5,433) 2.2 (0.4) 35,600 (5,750) 2.4 (0.4) 214,500 (17,819) 14.7 (1.0) 

590,595,597,599.0) †12,000 (3,481) †0.8 (0.2) * * * * 59,800 (7,909) 4.1 (0.5) 

e. . . . . .(680–709) 70,000 (8,465) 4.8 (0.5) 71,100 (8,466) 4.9 (0.5) 132,300 (11,780) 9.1 (0.8) 

. . . . . . . .(682.0) 21,700 (4,006) 1.5 (0.3) 19,700 (3,914) 1.3 (0.3) 28,300 (4,770) 1.9 (0.3) 

. . . . . . . .(707.0) 22,300 (3,936) 1.5 (0.3) 23,400 (4,020) 1.6 (0.3) 46,500 (6,121) 3.2 (0.4) 

connective 

. . . . . .(710–739) 127,600 (11,660) 8.7 (0.7) 128,800 (12,009) 8.8 (0.7) 480,700 (34,236) 32.9 (1.7) 
ses for home health care patients: United States, 2007—Con.

Primary diagnoses2 All-listed diagnoses3

At admission At interview At interview

(Standard Percent (Standard (Standard Percent (Standard (Standard (Standard

de1 Number error) distribution error) Number error) distribution error) Number error) Percent error)

. . . . . . . . .(714) * * * * * * * * 23,100 (4,670) 1.6 (0.3)

pine . . . . . .(715) 21,200 (4,142) 1.5 (0.3) 23,100 (4,584) 1.6 (0.3) 145,600 (15,322) 10.0 (0.9)

710–713, 716–719) 41,200 (6,566) 2.8 (0.4) 37,200 (6,999) 2.6 (0.5) 148,700 (17,600) 10.2 (1.1)

. . . . . . . .(733.0) * * * * * * * * 55,500 (7,742) 3.8 (0.5)

20–732,733.2–739) 51,200 (6,523) 3.5 (0.4) 52,600 (6,476) 3.6 (0.4) 206,500 (18,817) 14.1 (1.1)

. . . . . .(780–799) 147,700 (14,881) 10.1 (0.9) 143,900 (13,730) 9.9 (0.9) 551,100 (35,351) 37.8 (1.7)

. . . . . .(800–999) 68,700 (8,902) 4.7 (0.6) 66,800 (8,851) 4.6 (0.6) 106,400 (10,868) 7.3 (0.7)

. . . . . .(V01–V82) 158,100 (15,388) 10.8 (0.9) 143,000 (14,492) 9.8 (0.9) 345,200 (32,485) 23.6 (1.8)

.3–V53.7,V54–V58) 151,300 (15,221) 10.4 (0.9) 136,700 (14,311) 9.4 (0.9) 294,500 (28,111) 20.2 (1.6)

recision because the sample size is between 30 and 59, or the sample size is greater than 59 but has a relative standard error of 30% or more.

ecision because the sample size is fewer than 30.

h Revision, Clinical Modification.

current use of home health care.

interview.

distributions may not add to 100%, because of rounding and because the denominators for percent distributions may include a category of unknowns not reported in the table.

spice Care Survey, 2007.

National Health Statistics Reportsn Number 38n April 27, 2011 Page 13
Page 14 National Health Statistics Reports

n Number 38n April 27, 2011

me health care patients at interview, by selected characteristics: United States, 2007

Number of advance care planning instruments (standard error) Type of advance care planning instrument (standard error)

None

At

least one One

Two or

more

Living

will

Durable

power of

attorney DNR1

Health

care proxy Other2

. . . . . . . . . . . . 71.5 (1.7) 28.6 (1.7) 16.2 (1.3) 12.1 (1.2) 16.8 (1.3) 13.7 (1.3) 6.8 (0.8) 5.2 (1.2) 1.6 (0.4)

............

............

............

............

........................

............

82.688.078.966.476.166.458.4

(1.7)(2.4)(2.3)(2.1)(2.6)(2.8)(2.9)

17.4 (1.7)12.0 (2.4)21.2 (2.3)33.6 (2.2)23.9 (2.6)33.6 (2.8)41.6 (3.0)

9.8 (1.4)

†6.1 (1.7)12.3 (1.9)19.1 (1.6)14.4 (2.1)19.4 (2.2)22.6 (2.4)

7.6 (1.3)

†5.9 (1.8)

8.8 (1.9)

14.1 (1.5)

9.4 (2.1)

13.5 (2.0)18.7 (2.2)

10.0 (1.4)

* *

13.5 (2.2)19.8 (1.6)14.2 (2.0)19.8 (2.2)24.4 (2.5)

9.2 (1.5)

†5.6 (1.7)

11.6 (2.1)

15.8 (1.5)

11.4 (1.9)

15.2 (2.1)20.2 (2.2)

2.7 (0.8)

* *

†2.1 (0.6)

8.6 (1.0)5.9 (1.6)8.2 (1.5)

11.4 (1.6)

†4.2 (1.2)

* *

* *

5.6 (1.4)

* *

†5.4 (1.7)†6.4 (1.6)

†0.9 (0.4)

* *

* *

2.0 (0.5)

* *

†1.5 (0.6)†2.5 (0.8)

. . . . . . . . . . . .

. . . . . . . . . . . .

72.570.9

(2.3)(2.0)

27.5 (2.3)29.2 (2.0)

15.3 (1.6)16.7 (1.6)

12.0 (1.7)12.1 (1.3)

16.6 (1.8)16.8 (1.5)

12.1 (1.7)14.7 (1.5)

7.7 (1.2)6.2 (0.8)

5.9 (1.6)4.7 (1.1)

†0.8 (0.2)

2.1 (0.6)

............

............

............

87.769.579.0

(2.9)(1.9)(3.6)

†12.4 (2.9)

30.5 (1.9)

†21.0 (3.6)

* *

17.3 (1.4)

* *

* *

12.9 (1.3)

* *

* *

17.8 (1.4)

* *

* *

14.9 (1.4)

* *

* *

7.4 (0.9)

* *

* *

5.4 (1.2)

* *

* *

1.7 (0.4)

* *

........................

............

68.087.583.7

(1.8)(2.1)(5.1)

32.0 (1.8)12.5 (2.1)

* *

17.7 (1.5)†9.3 (1.7)

* *

14.0 (1.3)

* ** *

18.6 (1.4)

* ** *

15.5 (1.4)

* ** *

8.0 (0.9)

* ** *

5.6 (1.3)

* ** *

2.0 (0.5)

* ** *

............

. . . . . . . . . . . .

71.471.2

(2.4)(1.9)

28.6 (2.4)28.8 (1.9)

15.5 (2.0)16.7 (1.4)

12.5 (1.7)12.0 (1.3)

15.5 (1.6)

17.4 (1.5)

13.0 (1.9)14.2 (1.5)

7.7 (1.1)6.3 (0.9)

6.0 (1.5)4.9 (1.2)

* *

1.3 (0.4)

. . . . . . . . . . . .

............

............

75.366.269.2

(2.1)(2.9)(7.3)

24.7 (2.1)

33.8 (2.9)30.8 (7.3)

15.0 (1.5)

19.4 (2.4)

7.4 (2.0)

9.2 (1.3)

14.4 (2.2)

†23.4 (7.2)

14.2 (1.5)

19.7 (2.3)

21.5 (5.5)

10.8 (1.5)

17.3 (2.4)

†17.1 (5.2)

5.9 (0.9)7.1 (1.3)

†12.0 (4.4)

†2.8 (0.9)

†6.7 (2.4)

†15.8 (7.2)

†1.7 (0.6)

†1.7 (0.5)

* *

............

............

76.169.6

(2.5)(2.2)

23.9 (2.5)

30.4 (2.2)

16.0 (1.8)

16.3 (1.6)

7.8 (1.3)

13.8 (1.6)

11.8 (1.5)

18.7 (1.7)

12.4 (1.9)14.2 (1.6)

5.4 (1.1)7.3 (1.0)

* *

6.7 (1.6)

* *

1.8 (0.5)

.............

. . . . . . . . . . . .

............

............

71.8 (2.0)

69.5 (4.3)71.3 (4.4)63.4 (13.2)

28.2 (2.0)30.5 (4.3)28.7 (4.3)

* *

15.9 (1.4)24.2 (3.3)

†10.7 (4.0)

* *

12.1 (1.4)

* *

†16.3 (3.6)

* *

17.3 (1.5)

†14.4 (2.9)

†12.3 (3.8)

* *

13.6 (1.4)

†12.6 (3.6)†12.5 (4.2)

* *

6.4 (0.9)

* *

†12.1 (3.1)

* *

5.0 (1.4)

* *

* *

* *

1.5 (0.3)

* *

* *

* *
National Health Statistics Reports

n Number 38n April 27, 2011 Page 15

me health care patients at interview, by selected characteristics: United States, 2007—Con.

Number of advance care planning instruments (standard error) Type of advance care planning instrument (standard error)

None

At

least one One

Two or

more

Living

will

Durable

power of

attorney DNR1

Health

care proxy Other2

............

............

............

............

69.2 (4.2)67.4 (3.7)76.6 (2.2)65.4 (5.0)

30.8 (4.2)32.6 (3.7)23.4 (2.3)34.6 (5.0)

19.2 (3.9)17.8 (2.3)12.5 (1.4)21.0 (4.1)

11.6 (2.9)

14.8 (2.8)10.3 (1.8)13.6 (2.7)

16.1 (3.3)20.7 (2.7)14.2 (1.9)18.7 (3.1)

9.5 (2.1)

18.5 (3.1)

11.3 (1.8)

18.3 (3.6)

†7.8 (2.0)

6.3 (1.4)5.5 (1.0)

†10.0 (3.1)

12.7 (3.5)†3.6 (2.3)†4.1 (1.7)

* *

* *

†1.9 (0.8)†1.5 (0.7)

†2.5 (0.8)

............

...........

............

70.9 (2.0)73.1 (3.0)75.1 (2.5)

29.1 (2.0)27.0 (3.0)24.9 (2.5)

16.4 (1.5)15.5 (2.0)14.7 (1.6)

12.3 (1.5)

11.5 (1.5)

10.1 (1.4)

17.0 (1.5)15.5 (2.1)15.4 (1.9)

13.9 (1.5)13.9 (2.0)10.8 (1.8)

6.6 (0.9)7.9 (1.1)

7.3 (1.2)

5.7 (1.4)

†2.1 (0.5)†3.2 (0.9)

†1.7 (0.5)†1.6 (0.5)†1.4 (0.6)

recision because the sample size is between 30 and 59, or the sample size is greater than 59 but has a relative standard error of 30% or more.

ecision because the sample size is fewer than 30.

y department, feeding restrictions, medication restrictions, organ donation, and all other advance care planning requests not otherwise specified.

ander, American Indian or Alaska Native, and multiple races. All race categories include persons of Hispanic and non-Hispanic origin. Persons of Hispanic origin may be of any race.

ns at least one urbanized area of 50,000 or more population. The area may also contain other counties that are economically and socially integrated with the central county, as measured by commuting.

nmetropolitan counties that contains an urban cluster of 10,000–49,999 persons. The area may include surrounding counties if there are strong economic ties between the counties, based on commuting

distributions may not add to 100%, because of rounding and because the denominators for percent distributions may include a category of unknowns not reported in the table. Respondents did not know

ese were assumed to have no advance care planning.

spice Care Survey, 2007.
Page 16 National Health Statistics Reports n Number 38 n April 27, 2011

Table 5. Selected characteristics of annual hospice care discharges: United States, 2007

(Standard Percent (Standard

Characteristic Number error) distribution error)

Total. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1,045,100 (42,741) 100.0 . . .

Age1

Under 65 years ............................. 177,000 (11,442) 16.9 (0.9)

Under 45 years ........................... 13,600 (2,775) 1.3 (0.3)

45–64 years ............................. 163,400 (11,114) 15.6 (0.8)

65 years and over ........................... 868,100 (36,613) 83.1 (0.9)

65–69 years ............................. 71,900 (9,020) 6.9 (0.8)

70–74 years ............................. 89,100 (8,308) 8.5 (0.7)

75–79 years ............................. 137,400 (9,341) 13.1 (0.8)

80–84 years ............................. 170,600 (12,143) 16.3 (0.9)

85–89 years ............................. 202,700 (13,791) 19.4 (1.0)

90–94 years ............................. 135,800 (11,464) 13.0 (0.9)

95 years and over.......................... 60,600 (6,426) 5.8 (0.6)

Sex

Male ................................... 469,500 (24,781) 44.9 (1.4)

Female .................................. 575,500 (26,951) 55.1 (1.4)

Hispanic or Latino origin

Hispanic or Latino ........................... 41,400 (7,556) 4.0 (0.7)

Not Hispanic or Latino......................... 960,700 (41,533) 91.9 (1.1)

Unknown................................. 43,000 (8,925) 4.1 (0.9)

Race

White ................................... 948,100 (39,266) 90.7 (1.0)

Black ................................... 78,100 (10,725) 7.5 (0.9)

Other2 .................................. 18,800 (3,837) 1.8 (0.4)

Living arrangements3

Living alone ............................... 73,100 (8,301) 11.2 (1.2)

Living with others. . . . . . . . . . . . . . . . . . . . . . . . . . . . 575,300 (29,186) 87.9 (1.2)

Discharge status

Deceased ................................ 880,700 (37,817) 84.3 (1.1)

Not deceased .............................. 163,300 (13,571) 15.6 (1.1)

Ownership

Proprietary................................ 325,600 (39,526) 31.2 (3.4)

Voluntary nonprofit ........................... 696,900 (42,410) 66.7 (3.4)

Government or other ......................... 22,500 (6,213) 2.2 (0.6)

Chain affiliation

Part of a chain ............................. 284,700 (37,584) 27.2 (3.3)

Not part of a chain ........................... 760,400 (42,747) 72.8 (3.3)

Certification

Medicare and Medicaid ........................ 980,500 (43,168) 93.8 (1.5)

Medicare ................................. 50,400 (13,996) 4.8 (1.3)

Medicaid ................................. * * * *

Not certified4 .............................. †12,900 (7,163) †1.2 (0.7)

Geographic region

Northeast ................................ 192,800 (30,246) 18.4 (2.7)

Midwest ................................. 251,300 (31,860) 24.1 (2.9)

South ................................... 397,600 (38,484) 38.0 (3.4)

West ................................... 203,300 (27,164) 19.5 (2.5)

Location of agency

Metropolitan statistical area5 ..................... 913,500 (42,073) 87.4 (0.8)

Micropolitan statistical area6 ..................... 93,800 (6,949) 9.0 (0.7)

Neither .................................. 37,800 (3,943) 3.6 (0.4)

. . . Category not applicable.

* Estimate does not meet standards of reliability or precision because the sample size is fewer than 30.

† Estimate does not meet standards of reliability or precision because the sample size is between 30 and 59, or the sample size is greater than 59 but has a relative standard error of 30% or 

more. 1

Patient’s age at time of discharge. 2

Includes Asian, Native Hawaiian or Other Pacific Islander, American Indian or Alaska Native, and multiple races. All race categories include persons of Hispanic and non-Hispanic origin. Persons 

of Hispanic origin may be of any race. 
National Health Statistics Reports n Number 38 n April 27, 2011 Page 17

3

Respondents were not asked about the living arrangements of discharged hospice care patients who received care in an inpatient setting. These patients were excluded from the numerator and 

denominator for this question. 4

Includes agencies pending certification. 5

A county or group of contiguous counties that contains at least one urbanized area of 50,000 or more population. The area may also contain other counties that are economically and socially 

integrated with the central county, as measured by commuting. 6

A nonmetropolitan county or group of contiguous nonmetropolitan counties that contains an urban cluster of 10,000–49,999 persons. The area may include surrounding counties if there are strong 

economic ties between the counties, based on commuting patterns. 

NOTE: Numbers may not add to totals, and percent distributions may not add to 100%, because of rounding and because the denominators for percent distributions may include a category of 

unknowns not reported in the table. 

DATA SOURCE: CDC/NCHS, National Home and Hospice Care Survey, 2007. 
Page 18 National Health Statistics Reports n Number 38 n April 27, 2011

Table 6. Length of service (in days) of annual hospice care discharges, by selected characteristics: United States, 2007

(Standard (Standard

Characteristic Number Percent Mean error) Median error)

Total. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1,045,100 100.0 65 (3.5) 16 (1.0)

Age1

Under 65 years ......................................... 177,000 16.9 42 (4.9) 15 (1.8)

65 years and over ....................................... 868,100 83.1 70 (3.9) 16 (1.3)

65–74 years ......................................... 161,000 15.4 48 (6.8) 12 (2.3)

75–84 years ......................................... 308,000 29.5 68 (5.9) 15 (2.0)

85 years and over...................................... 399,100 38.2 80 (6.1) 20 (2.8)

Sex

Male ............................................... 469,500 44.9 53 (4.5) 15 (1.7)

Female . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 575,500 55.1 75 (4.8) 18 (1.2)

Hispanic or Latino origin

Hispanic or Latino ....................................... 41,400 4.0 64 (15.0) 16 (4.5)

Not Hispanic or Latino..................................... 960,700 91.9 65 (3.5) 16 (1.1)

Unknown............................................. 43,000 4.1 69 (20.7) †16 (6.2)

Race

White . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 948,100 90.7 65 (3.4) 16 (1.2)

Black . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 78,100 7.5 75 (13.4) 21 (4.1)

Other2 .............................................. 18,800 1.8 46 (8.8) 21 (6.0)

Living arrangements3

Living alone . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 73,100 11.2 109 (11.8) 48 (8.5)

Living with others. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 575,300 87.9 62 (3.6) 20 (1.5)

Discharge status

Deceased ............................................ 880,700 84.3 52 (3.2) 13 (1.1)

Not deceased .......................................... 163,300 15.6 138 (9.3) 79 (8.0)

Primary source of payment4

Private5.............................................. 104,200 10.0 40 (6.8) 12 (2.1)

Medicare . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 828,900 79.3 70 (4.0) 17 (1.3)

Medicaid . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 39,900 3.8 68 (14.0) †21 (10.0)

All other sources6 ....................................... 28,900 2.8 36 (6.5) 17 (4.6)

Ownership

Proprietary. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 325,600 31.2 83 (7.0) 20 (3.1)

Voluntary nonprofit ....................................... 696,900 66.7 57 (3.9) 15 (1.2)

Government or other ..................................... 22,500 2.2 60 (7.7) 20 (3.8)

Chain affiliation

Part of a chain ......................................... 284,700 27.2 83 (7.8) 19 (3.3)

Not part of a chain ....................................... 760,400 72.8 59 (3.6) 15 (1.2)

Certification

Medicare and Medicaid . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 980,500 93.8 63 (3.5) 16 (1.1)

Medicare . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 50,400 4.8 103 (20.3) 29 (5.0)

Medicaid . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . * * * * * *

Not certified7 .......................................... †12,900 †1.2 75 (22.2) †20 (18.3)

Geographic region

Northeast ............................................ 192,800 18.4 56 (7.7) 14 (2.2)

Midwest ............................................. 251,300 24.1 58 (6.5) 14 (1.9)

South . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 397,600 38.0 76 (6.3) 19 (1.9)

West ............................................... 203,300 19.5 61 (6.4) 16 (2.1)

Location of agency

Metropolitan statistical area8 ................................. 913,500 87.4 64 (3.9) 16 (1.3)

Micropolitan statistical area9 ................................. 93,800 9.0 74 (6.4) 18 (2.3)

Neither . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 37,800 3.6 65 (6.2) 15 (2.3)

† Estimate does not meet standards of reliability or precision because the sample size is between 30 and 59, or the sample size is greater than 59 but has a relative standard error of 30% or

more.

* Estimate does not meet standards of reliability or precision because the sample size is fewer than 30.

1

Patient’s age at time of discharge.

2

Includes Asian, Native Hawaiian or Other Pacific Islander, American Indian or Alaska Native, and multiple races. All race categories include persons of Hispanic and non-Hispanic origin. Persons

of Hispanic origin may be of any race.

3

Respondents were not asked about the living arrangements of discharged hospice care patients who received care in an inpatient setting (37.4% of all discharges).
National Health Statistics Reports n Number 38 n April 27, 2011 Page 19

4

At time of discharge. 5

Includes private health insurance, long-term care insurance, and self-pay by patient or family. 6

Includes Tricare, Department of Veteran Affairs, ChampVA, worker’s compensation, other government, no charge for care, other source, and payment source not yet determined. 7

Includes agencies pending certification. 8

A county or group of contiguous counties that contains at least one urbanized area of 50,000 or more population. The area may also contain other counties that are economically and socially 

integrated with the central county, as measured by commuting. 9

A nonmetropolitan county or group of contiguous nonmetropolitan counties that contains an urban cluster of 10,000–49,999 persons. The area may include surrounding counties if there are strong 

economic ties between the counties, based on commuting patterns. 

NOTES: Numbers may not add to totals, and percent distributions may not add to 100%, because of rounding and because the denominators for percent distributions may include a category of 

unknowns not reported in the table. For length of service, six unknowns are excluded from the mean and median calculations. 

DATA SOURCE: CDC/NCHS, National Home and Hospice Care Survey, 2007. 
Page 20 National Health Statistics Reports n Number 38 n April 27, 2011 

ses for annual hospice care discharges: United States, 2007 Primary diagnoses2 All-listed diagnoses3 At admission At discharge At discharge (Standard Percent (Standard (Standard Percent (Standard (Standard (Standard 

M code1 Number error) distribution error) Number error) distribution error) Number error) Percent error) 

.................. 1,045,100 . . . 100.0 . . . 1,045,100 . . . 100.0 . . . . . . . . . . . . . . . 

. . . . . . . . . . . .(001–139) †6,900 (2,323) †0.6 (0.2) †7,100 (2,418) †0.7 (0.2) 37,400 (5,808) 3.6 (0.5) 

. . . . . . . . . . . .(140–239) 454,600 (24,919) 43.5 (1.5) 454,200 (24,976) 43.5 (1.5) 491,300 (25,888) 47.0 (1.5) 

. . . . . .(140–208,230–234) 447,600 (24,894) 42.8 (1.5) 447,600 (24,894) 42.8 (1.5) 485,300 (25,955) 46.4 (1.5) 

d rectum . . .(153–154,197.5) 47,000 (6,762) 4.5 (0.6) 46,600 (6,754) 4.5 (0.6) 52,400 (6,902) 5.0 (0.6) 

and lung. .(162,197.0,197.3) 129,000 (10,380) 12.3 (0.8) 128,700 (10,387) 12.3 (0.8) 161,400 (12,426) 15.4 (1.0) 

tissue and skin. . .(170–173, 198.2,198.5) 15,900 (3,231) 1.5 (0.3) 15,900 (3,230) 1.5 (0.3) 38,200 (5,069) 3.7 (0.4) 

. . . . . . .(174–175,198.81) 28,700 (4,733) 2.7 (0.4) 28,500 (4,731) 2.7 (0.4) 40,700 (5,288) 3.9 (0.5) 

gans. . . . . .(179–184,198.6) 21,500 (3,867) 2.1 (0.4) 21,400 (3,866) 2.1 (0.4) 25,200 (4,170) 2.4 (0.4) 

. . . . . . . . . . . . . . .(185) 17,100 (3,005) 1.6 (0.3) 16,800 (2,969) 1.6 (0.3) 37,300 (5,131) 3.6 (0.5) 

. . . .(188–189,198.0–198.1) 30,600 (5,207) 2.9 (0.5) 30,600 (5,207) 2.9 (0.5) 35,900 (5,959) 3.4 (0.5) 

sue . . . . . . . . . .(200–208) 30,600 (4,335) 2.9 (0.4) 31,300 (4,459) 3.0 (0.4) 36,400 (4,781) 3.5 (0.4) 

fied 

3–165,176,186–187,190–196, 

7.4,197.6–197.8,198.3–198.4, 198.7,198.82–199,230–234) 125,700 (11,805) 12.0 (1.0) 126,000 (11,819) 12.1 (1.0) 193,500 (15,962) 18.5 (1.2) 

s and immunity 

. . . . . . . . . . . .(240–279) * * * * * * * * 207,900 (15,859) 19.9 (1.3) 

. . . . . . . . . . . . . . .(250) * * * * * * * * 127,700 (10,298) 12.2 (0.9) 

ans . . . . . . . . . .(280–289) * * * * * * * * 70,000 (8,358) 6.7 (0.7) 

. . . . . . . . . . . .(280–285) * * * * * * * * 64,300 (8,212) 6.2 (0.7) 

. . . . . . . . . . . .(290–319) 69,100 (7,797) 6.6 (0.7) 70,800 (7,979) 6.8 (0.7) 234,300 (18,168) 22.4 (1.3) 

. . . . . . . . . . . .(290,310) * * * * * * * * *14800 (4,096) *1.4 (0.4) 

. . . . . .(291–309,311–316) 61,900 (7,238) 5.9 (0.6) 64,000 (7,689) 6.1 (0.7) 219,400 (17,406) 21.0 (1.3) 

rgans. . . . . . . . .(320–389) 81,400 (8,350) 7.8 (0.7) 80,200 (8,353) 7.7 (0.7) 165,700 (12,906) 15.9 (1.0) 

. . . . . . . . . . . . . .(331.0) 40,400 (5,448) 3.9 (0.5) 39,400 (5,332) 3.8 (0.5) 64,200 (6,654) 6.1 (0.6) 

. . . . . . . . . . . . . . .(332) †20,500 (4,420) †1.9 (0.4) †21,000 (4,441) †2.0 (0.4) 44,900 (6,520) 4.3 (0.6) 

nd sense organs. . . . .(320– 

331.9,333–337,341,345–389) †18,600 (3,923) †1.8 (0.4) †18,800 (3,979) †1.8 (0.4) 65,100 (7,518) 6.2 (0.7) 

. . . . . . . . . . . .(390–459) 165,100 (12,450) 15.8 (1.1) 165,700 (12,258) 15.9 (1.0) 523,000 (27,842) 50.0 (1.8) 

. . . . . . . . . . . . . . .(401) * * * * * * * * 245,500 (18,488) 23.5 (1.4) 

391–392.0,393–398,402,404, 410–416,420–429) 115,600 (10,001) 11.1 (0.9) 117,400 (9,997) 11.2 (0.9) 336,300 (19,437) 32.2 (1.4) 

. . . . . . . . . . . . . .(414.0) * * * * * * * * 22,100 (5,282) 2.1 (0.5) 

. . . . . . .(412,414.1–414.9) *7,700 (2,157) †0.74 (0.2) †8,200 (2,179) †0.8 (0.2) 98,500 (9,911) 9.4 (0.8) 

. . . . . . . . . . . . . . .(427) * * * * * * * * 66,000 (7,141) 6.3 (0.6) 

. . . . . . . . . . . . . .(428.0) 66,400 (6,935) 6.4 (0.6) 65,200 (6,914) 6.2 (0.6) 161,200 (12,401) 15.4 (1.0) 

0,393–398,415–416,420–426, 428.1–429) 35,300 (5,538) 3.4 (0.5) 37,300 (5,613) 3.6 (0.5) 97,500 (9,288) 9.3 (0.8) 

. . . . . .(430–435,437–438) 46,800 (5,972) 4.5 (0.5) 45,100 (5,919) 4.3 (0.5) 114,000 (11,121) 10.9 (0.9) 

. . .(390,392.9,403,405,417, 440–459) * * * * * * * * 67,400 (8,252) 6.4 (0.7) 
ses for annual hospice care discharges: United States, 2007—Con.

Primary diagnoses2 All-listed diagnoses3

At admission At discharge At discharge

(Standard Percent (Standard (Standard Percent (Standard (Standard (Standard

M code1 Number error) distribution error) Number error) distribution error) Number error) Percent error)

. . . . . . . . . . . .(460–519) 77,900 (6,828) 7.5 (0.6) 79,900 (6,854) 7.6 (0.6) 225,500 (15,040) 21.6 (1.1)

. . . . . . . . . . . .(480–486) * * * * * * * * 38,200 (6,594) 3.7 (0.6)

allied conditions. .(490–491) 49,600 (5,629) 4.7 (0.5) 51,200 (5,724) 4.9 (0.5) 154,800 (11,856) 14.8 (1.0)

. . . .(460–478,487,500–519) 25,800 (4,215) 2.5 (0.4) 25,300 (4,086) 2.4 (0.4) 52,500 (6,224) 5.0 (0.5)

. . . . . . . . . . . .(520–579) 18,100 (3,477) 1.7 (0.3) 17,600 (3,459) 1.7 (0.3) 120,300 (11,379) 11.5 (1.0)

. . . . . . . . . . . .(580–629) 31,700 (4,613) 3.0 (0.4) 32,100 (4,636) 3.1 (0.4) 151,300 (11,564) 14.5 (1.0)

(580–583,590,595,597,599.0) * * * * * * * * 30,000 (4,944) 2.9 (0.5)

connective tissue. .(710–739) * * * * * * * * 94,300 (10,144) 9.0 (0.9)

. . . . . .(710–713,716–719) * * * * * * * * 26,900 (4,756) 2.6 (0.4)

...............733.0 * * * * * * * * 25,200 (4,782) 2.4 (0.4)

em . . .(720–732,733.2–739) * * * * * * * * 19,500 (3,508) 1.9 (0.3)

. . . . . . . . . . . .(780–799) 127,400 (10,482) 12.2 (0.9) 121,700 (10,419) 11.6 (0.9) 216,100 (14,334) 20.7 (1.2)

. . . . . . . . . . . .(800–999) * * * * * * * * †10,500 (2,792) †1.0 (0.3)

. . . . . . . . . . . .(V01–V82) * * * * * * * * 41,300 (6,997) 4.0 (0.6)

6,V52,V53.3–V53.7,V54–V58) * * * * * * * * 22,000 (3,621) 2.1 (0.3)

recision because the sample size is between 30 and 59, or the sample size is greater than 59 but has a relative standard error of 30% or more.

ecision because the sample size is fewer than 30.

h Revision, Clinical Modification.

spice care.

discharge.

distributions may not add to 100%, because of rounding and because the denominators for percent distributions may include a category of unknowns not reported in the table.

spice Care Survey, 2007.

National Health Statistics Reportsn Number 38n April 27, 2011 Page 21
Page 22 National Health Statistics Reports

n Number 38n April 27, 2011

nual hospice care discharges, by selected characteristics: United States, 2007

Number of advance care planning instruments (standard error) Type of advance care planning instrument (standard error)

Durable

At Three Living power of Health Comfort

None least one One Two or more will attorney DNR1 care proxy measures Other2

. . . . . . . . . . 11.6 (1.3) 88.4 (1.3) 36.1 (1.8) 25.4 (1.5) 26.9 (1.9) 25.3 (1.7) 36.4 (2.1) 80.2 (1.7) 15.9 (1.7) 11.5 (1.5) 11.6 (1.5)

.......... 18.7 (2.7) 81.3 (2.7) 39.9 (3.1) 21.0 (2.5) 20.4 (2.7) 19.0 (2.4) 30.5 (3.1) 71.9 (3.1) 12.9 (2.2) 7.0 (1.5) 10.5 (2.2)

.......... 10.2 (1.3) 89.8 (1.3) 35.3 (1.8) 26.3 (1.7) 28.3 (2.0) 26.6 (1.9) 37.6 (2.2) 81.8 (1.8) 16.5 (1.9) 12.5 (1.7) 11.8 (1.5)

.......... 16.1 (4.2) 83.9 (4.2) 40.4 (3.7) 21.7 (3.0) 21.9 (3.1) 21.5 (3.1) 27.0 (3.3) 74.8 (4.4) 16.0 (3.1) 10.3 (2.5) 11.4 (2.6)

.......... 11.4 (1.7) 88.6 (1.7) 34.5 (2.5) 25.4 (2.2) 28.7 (2.4) 25.1 (2.3) 36.3 (2.5) 82.5 (2.0) 16.4 (2.2) 11.3 (1.7) 11.6 (1.6)

.......... 6.9 (1.1) 93.1 (1.1) 33.8 (2.4) 28.8 (2.3) 30.5 (2.7) 29.8 (2.5) 42.9 (3.0) 84.2 (2.2) 16.9 (2.2) 14.2 (2.4) 12.2 (1.8)

.......... 12.3 (1.5) 87.7 (1.5) 38.1 (2.2) 24.4 (1.9) 25.2 (2.2) 24.0 (2.1) 32.7 (2.5) 80.0 (2.0) 16.1 (2.2) 10.9 (1.5) 10.3 (1.5)

. . . . . . . . . . 11.1 (1.5) 88.9 (1.5) 34.4 (2.1) 26.2 (1.9) 28.4 (2.1) 26.4 (2.0) 39.4 (2.4) 80.3 (2.0) 15.8 (1.8) 12.1 (1.8) 12.7 (1.7)

.......... * * 81.9 (6.0) 47.8 (7.2) * * * * * * †17.8 (5.0) 77.5 (5.9) * * * * * *

.......... 10.9 (1.2) 89.1 (1.2) 35.5 (1.8) 25.8 (1.6) 27.9 (2.0) 25.9 (1.8) 37.2 (2.2) 80.9 (1.6) 16.3 (1.8) 12.0 (1.6) 12.1 (1.5)

.......... * * 77.9 (6.8) †37.7 (7.9) * * * * * * †36.2 (6.9) 65.4 (9.4) * * * * * *

. . . . . . . . . . 10.6 (1.3) 89.4 (1.3) 34.4 (1.8) 26.6 (1.6) 28.4 (2.0) 26.6 (1.8) 38.0 (2.2) 81.2 (1.7) 16.9 (1.8) 12.0 (1.6) 12.4 (1.5)

. . . . . . . . . . 20.5 (4.6) 79.5 (4.6) 54.5 (4.7) †13.3 (3.5) †11.6 (2.7) †10.6 (2.6) †22.1 (4.6) 71.0 (5.1) * * * * * *

.......... * * 75.5 (7.3) †42.8 (8.2) * * * * * * * * †66.6 (7.4) * * * * * *

.......... †10.7 (3.0) 89.2 (3.0) 44.6 (5.3) 23.1 (3.8) 21.4 (3.8) 23.5 (4.8) 38.7 (5.4) 74.8 (5.1) †9.12 (2.6) †9.5 (2.6) †13.5 (3.7)

. . . . . . . . . . 12.1 (1.5) 87.9 (1.5) 36.4 (2.1) 23.7 (1.8) 27.7 (2.2) 26.8 (2.0) 35.9 (2.6) 78.8 (1.9) 16.2 (2.0) 11.8 (1.7) 10.6 (1.6)

.......... 9.4 (1.2) 90.6 (1.2) 36.2 (2.0) 26.3 (1.6) 28.0 (2.0) 26.2 (1.9) 37.6 (2.2) 82.7 (1.7) 16.5 (1.9) 12.4 (1.6) 11.6 (1.5)

.......... 23.0 (3.9) 77.0 (3.9) 35.3 (3.2) 20.5 (2.8) 21.2 (2.5) 20.5 (2.5) 29.9 (3.3) 67.2 (4.2) 13.0 (2.0) 6.7 (1.6) 11.5 (2.2)

. . . . . . . . . . 15.8 (2.9) 84.2 (2.9) 37.3 (3.4) 24.6 (3.4) 22.4 (2.9) 19.0 (2.5) 36.6 (3.7) 77.0 (3.3) 11.4 (2.2) 9.9 (2.3) 13.1 (2.5)

.......... 9.6 (1.3) 90.4 (1.3) 35.9 (2.1) 26.0 (1.6) 28.5 (2.4) 27.8 (2.2) 36.6 (2.7) 81.6 (2.0) 17.6 (2.3) 12.1 (2.0) 10.5 (1.8)

.......... †14.9 (4.3) 85.0 (4.3) 21.8 (4.3) 17.9 (3.5) 45.4 (8.2) 40.7 (5.4) †25.5 (7.8) 80.3 (4.1) 28.4 (5.8) †17.6 (8.2) †23.3 (10.0)

.......... 17.8 (3.4) 82.2 (3.4) 34.6 (3.6) 27.4 (3.9) 20.2 (3.1) 16.8 (2.4) 37.9 (4.0) 75.1 (4.0) 10.0 (2.4) 8.9 (2.3) 12.1 (2.5)

.......... 9.3 (1.1) 90.7 (1.1) 36.6 (2.0) 24.6 (1.5) 29.4 (2.3) 28.5 (2.1) 35.8 (2.5) 82.0 (1.7) 18.2 (2.1) 12.5 (1.9) 11.4 (1.8)

.......... 11.3 (1.3) 88.7 (1.3) 36.7 (1.8) 25.3 (1.6) 26.7 (2.0) 24.8 (1.8) 35.9 (2.2) 80.3 (1.7) 15.6 (1.8) 11.3 (1.5) 11.6 (1.5)

. . . . . . . . . . †11.6 (4.4) 88.3 (4.4) 29.4 (5.0) 30.4 (6.5) †28.4 (7.9) 35.9 (7.2) 48.1 (8.6) 82.7 (6.6) †20.1 (8.7) * * * *

. . . . . . . . . . * * * * * * * * * * * * * * * * * * * * * *

.......... †32.3 (17.1) 67.7 (17.1) * * * * †38.1 (12.0) †21.5 (6.0) * * 61.7 (15.5) * * * * * *
National Health Statistics Reports

n Number 38n April 27, 2011 Page 23

nual hospice care discharges, by selected characteristics: United States, 2007—Con.

Number of advance care planning instruments (standard error) Type of advance care planning instrument (standard error)

None

At

least one One Two

Three

or more

Living

will

Durable

power of

attorney DNR1

Health

care proxy

Comfort

measures Other2

..........

..........

..........

..........

†11.5 (4.0)

7.4 (2.1)

15.3 (2.0)

9.8 (2.4)

88.5 (4.0)92.6 (2.1)84.7 (2.0)90.2 (2.4)

38.4 (4.5)30.9 (3.9)39.1 (2.6)34.2 (3.8)

24.3 (3.4)31.3 (3.4)19.7 (1.9)30.2 (4.0)

25.8 (5.4)30.4 (3.9)25.8 (3.1)25.9 (3.4)

28.4 (4.9)27.0 (3.4)27.8 (2.8)15.4 (2.7)

23.0 (6.4)49.0 (4.2)29.3 (2.8)47.4 (4.5)

83.0 (4.3)88.1 (2.3)74.2 (2.5)79.4 (4.6)

23.9 (4.6)10.9 (2.6)18.7 (3.2)

9.0 (2.2)

†11.7 (4.3)

13.5 (3.2)

7.5 (2.2)

16.8 (3.3)

10.8 (2.9)

9.5 (2.7)9.3 (2.7)

19.5 (3.0)

..........

..........

..........

11.7 (1.4)11.2 (1.6)11.2 (1.5)

88.3 (1.4)88.8 (1.6)88.7 (1.5)

36.6 (2.0)32.2 (2.6)32.3 (3.0)

25.4 (1.7)25.7 (1.9)23.9 (2.3)

26.3 (2.1)30.9 (3.1)32.6 (3.6)

24.5 (2.0)31.2 (2.4)31.5 (3.0)

35.9 (2.4)39.3 (2.6)40.4 (3.3)

80.5 (1.9)76.6 (3.5)80.3 (2.6)

16.2 (2.0)12.8 (1.8)17.6 (2.8)

11.1 (1.7)

14.3 (2.0)14.2 (2.4)

11.0 (1.6)

14.9 (2.8)

18.0 (4.2)

ecision because the sample size is fewer than 30.

ecision because the sample size is between 30 and 59, or the sample size is greater than 59 but has a relative standard error of 30% or more.

y department, feeding restrictions, medication restrictions, organ donation, and all other advance care planning requests not otherwise specified.

ander, American Indian or Alaska Native, and multiple races. All race categories include persons of Hispanic and non-Hispanic origin. Persons of Hispanic origin may be of any race.

ements of discharged hospice care patients who received care in an inpatient setting (37.4% of all discharges).

ns at least one urbanized area of 50,000 or more population. The area may also contain other counties that are economically and socially integrated with the central county, as measured by commuting.

nmetropolitan counties that contains an urban cluster of 10,000–49,999 persons. The area may include surrounding counties if there are strong economic ties between the counties, based on commuting

distributions may not add to 100%, because of rounding and because the denominators for percent distributions may include a category of unknowns not reported in the table. Respondents did not know

nts; these were assumed to have no advance care planning.

spice Care Survey, 2007.
Page 24 National Health Statistics Reports n Number 38 n April 27, 2011

Technical Notes

Findings presented in this report

were based on data from the home

health care patient and discharged

hospice care patient components of the

2000 and 2007 National Home and

Hospice Care Survey (NHHCS).

NHHCS is a continuing series of

cross-sectional, nationally representative

sample surveys of home health and

hospice care agencies in the United

States. The survey includes agencies that

are certified by Medicare or Medicaid,

or licensed by a state. Data from

NHHCS have been used to track

changes in home health and hospice

care provided to individuals and their

family members since 1992.

Sample design

The sampling design for NHHCS

was a stratified, two-stage probability

design. The first stage consisted of the

selection of a stratified sample of

agencies. The primary sampling strata of

agencies were defined by agency type,

metropolitan statistical area (MSA)

status, and census region in the 2000

survey. In contrast, agency type and

MSA status were used to define the

primary sampling strata in 2007. The

second stage of sample selection was

done using a sample selection table (in

2000) or a computer algorithm (in 2007)

to obtain systematic probability samples

of patients. In 2007, up to 10 current

home health care patients were

randomly selected per home health care

agency, up to 10 discharged hospice

care patients were randomly selected per

hospice agency, and a combination of up

to 10 current home health care patients

and discharged hospice care patients

were randomly selected per mixed

agency. Current home health care

patients were defined as patients who

were on the rolls of the agency as of

midnight of the day immediately before

the agency interview. Discharged

hospice care patients were defined as

patients who were discharged from the

hospice agency during the 3-month

period beginning 4 months before the

agency interview. Discharges that

occurred because of the death of a

sampled hospice patient were included.

Data collection

Data for NHHCS were collected

through personal interviews with agency

directors and staff who used

administrative records to answer

questions about the agencies, staffs,

services, and programs, and medical

records to answer questions about

patients. The agency component of

NHHCS interviews was completed for

1,425 agencies in 2000 and 1,036 in

2007. The first-stage agency unweighted

response rate was 96% in 2000 and 71%

in 2007. Starting with the 2007

NHHCS, the weighted response rate was

calculated. The first-stage agency

response rate weighted by the inverse of

the probability of selection was 59%.

The second-stage patient unweighted

response rate was 95%, and the

weighted response rate was 96% (8).

A detailed description of the

sampling design, data collection, and

procedures, including data collection

forms for each survey year, is provided

in other reports (8,15) and is available

from: http://www.cdc.gov/nchs/nhhcs/

nhhcs_questionnaires.htm.

Estimation

Because of the complex multistage

design of NHHCS, the National Center

for Health Statistics computed a weight

that took all sampling stages into

account. This weight was used to inflate

the sample numbers to national

estimates and included three basic

components: inflation by reciprocals of

selection probabilities, adjustment for

nonresponse, and population ratio

adjustment. Further information on

NHHCS estimation procedures is

available from: http://www.cdc.gov/nchs/

data/nhhcsd/NHHCS_NHHAS_

web_documentation.pdf.

Standard errors

Because the statistics presented in

this report are based on a sample, they

differ somewhat from statistics that

would have been obtained if a complete

census had been taken using the same

schedules, instructions, and procedures.

The standard errors (SEs) of statistics

presented in this report are included in

each table. The SEs used in this report

were approximated using SUDAAN

software, which computes SEs by using

a first-order Taylor approximation of the

deviation of estimates from their

expected values. A description of the

software has been published (11).

Estimates are considered reliable if they

are based on 60 or more sample cases

and the relative standard error (RSE) is

less than 30%. Estimates based on

30–59 cases, or based on more than 59

cases but with an RSE exceeding 30%,

are displayed with a dagger (†) and

cannot be assumed to be reliable.

Estimates based on fewer than 30 cases

[indicated with an asterisk (*)] are not

reported because they do not meet

standards of reliability or precision. SEs

can be calculated for patient estimates

using any statistical software package,

including SUDAAN, as long as

clustering within agencies and other

aspects of the complex sample design

are taken into account. Software

products such as SAS, STATA, and

SPSS all have these capabilities.

Definitions of terms

Terms relating to home health

care patients and discharged

hospice care patients

Home health care patient—A

patient on the home health care agency’s

roster as of midnight the night before

the interview. Weighted data represent

the total number of home health care

patients served each day in 2007.

Discharged hospice care patient—A

patient who is formally discharged from

care by the agency during the 3-month

period prior to the month of interview.

Both live and dead discharged hospice

care patients are included. Persons

receiving hospice care can be counted

more than once if the patient was

discharged more than once in the prior

12 months; therefore, discharged

patients represent episodes of care rather

than persons receiving hospice care.

Weighted data represent the total
National Health Statistics Reports n Number 38 n April 27, 2011	 Page 25

number of discharged hospice care

patients in all of 2007.

Terms relating to agencies

Chain—Defined as having two or

more agencies operating under one

corporate authority or corporate

ownership.

Certification—Refers to agency

certification by either or both Medicare

and Medicaid. Both programs can

certify home health care agencies and

hospices as meeting agency criteria for

participation. If a certification status was

pending, the agency was coded as not

certified for the analyses in this report.

Geographic region—Refers to a

region created by grouping the

conterminous states into geographic

areas corresponding to groups used by

the U.S. Census Bureau:

Region States included

Northeast	 Maine, New Hampshire,

Vermont, Massachusetts,

Rhode Island, Connecticut,

New York, New Jersey, and

Pennsylvania

Midwest	 Michigan, Ohio, Indiana,

Illinois, Wisconsin,

Minnesota, Iowa, Missouri,

North Dakota, South Dakota,

Kansas, and Nebraska

South	 Delaware, Maryland, District

of Columbia, Virginia, West

Virginia, North Carolina,

South Carolina, Georgia,

Florida, Kentucky, Texas,

Tennessee, Alabama,

Mississippi, Arkansas,

Louisiana, and Oklahoma

West	 Montana, Idaho, Wyoming,

Colorado, New Mexico,

Arizona, Utah, Nevada,

Washington, Oregon,

California, Alaska, and

Hawaii

Home health care—Refers to a

range of medical and therapeutic

services as well as other services

delivered at a patient’s home or in a

residential setting for the purpose of

promoting, maintaining, or restoring

health, or maximizing the level of

independence, while minimizing the

effects of disability and illness,

including terminal illness.

Hospice care—Focuses on relieving

pain and uncomfortable symptoms of

individuals with terminal illness and

providing emotional and spiritual

support to both the terminally ill and

their family members.

Location—The locale of the agency

providing services.

+	 Metropolitan statistical area—A

county or group of contiguous

counties that contain at least one

urbanized area of 50,000 or more

population. An MSA may contain

other counties that are economically

and socially integrated with the

central county, as measured by

commuting.

+	 Micropolitan statistical area—A

nonmetropolitan county or group of

contiguous nonmetropolitan counties

that contains an urban cluster of

10,000–49,999 persons. Surrounding

counties with strong economic ties,

measured by commuting patterns,

may also be included.

+	 Neither location—A location that

falls outside of the two types of areas

described previously.

Ownership—The type of

organization that controls and operates

the home health care or hospice care

agency.

+	 Proprietary or for-profit—An agency

operated under private commercial

ownership, including individual or

private ownership, partnerships, or

corporations.

+	 Voluntary nonprofit—An agency

operated under voluntary or nonprofit

auspices, including a church or other

nonprofit organization.

+	 Government and other means—An

agency operated under federal, state,

or local government and other

auspices not specified.

Terms relating to characteristics

Age—The patient’s age at the time

of interview (for home health care

patients) or at the time of discharge (for

discharged hospice care patients). Age is

calculated as the difference in years

between the date of birth and the date of

interview or discharge.

Deceased—Indicates whether the

hospice care patient was deceased at

time of discharge.

Hispanic or Latino origin—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.

Living arrangements—Indicates

whether home health care and

discharged hospice care patients lived

alone or lived with others (spouse or

significant other, parent, child, other

family member, or nonfamily member)

during the interview or at time of

discharge. This question was not asked

for discharged patients receiving hospice

care in an inpatient facility (37.4% of all

discharged patients).

Race—The patient’s racial

background as reported by agency staff.

Categories include American Indian or

Alaska Native; Asian; black or African

American; Native Hawaiian or Other

Pacific Islander; and white. Consistent

with the U.S. Office of Management

and Budget’s 1997 Standards for the

Classification of Federal Data on Race

and Ethnicity (16), respondents could

report more than one race category. The

race categories listed in this report

include white, black, and other. Other

race includes Asian, Native Hawaiian or

Other Pacific Islander, American Indian

or Alaska Native, and multiple races.

Only a small number of records had

multiple races indicated.

Terms relating to health and

functional status

Activities of daily living (ADLs) and

staff help with ADLs—Refers to five

limitations in activities (bathing,

dressing, transferring, using the toilet

room, and eating) that reflect the home

health care patient’s capacity for

self-care. Staff help with ADLs is

measured by the receipt of help from

agency staff among those with one or

more of the five limitations at the time

of the survey.
Page 26	 National Health Statistics Reports n Number 38 n April 27, 2011

Advance care planning—Verbal or

written declarations by patients—made

in advance of a situation in which they

may be incompetent to decide about

their own care—that state their

treatment preferences or authorizing a

third party to make decisions for them.

+ Advance directives—Legal documents

that include instructions given by

persons specifying what actions

should be taken for their health in the

event that they are no longer able to

make decisions due to illness or

incapacity, and that appoint a person

to make such decisions on their

behalf.

o	 Living will—A written document

that allows a person to state in

advance his or her wishes

regarding the use or removal of

life-sustaining or death-delaying

procedures in the event of illness

or injury.

o	 Durable power of attorney—A

written legal document by which

an individual designates another

person to act on his or her behalf.

The power is durable in the sense

that the authority endures in the

event the individual becomes

disabled or incapacitated.

o	 Health care proxy—A legal

document in which an individual

designates another person to make

health care decisions if he or she

is rendered incapable of making

his or her wishes known. The

health care proxy has, in essence,

the same rights to request or

refuse treatment that the individual

would have if capable of making

and communicating decisions.

+ Do not resuscitate—A written order

from a doctor that resuscitation

should not be attempted if a person

suffers cardiac or respiratory arrest.

Such an order may be instituted on

the basis of an advance directive

from the person or from someone

entitled to make decisions on his or

her behalf, such as a health care

proxy.

+ Comfort measures—Refers only to

pain medications, nursing care, and

treatments for the purpose of

providing comfort and relieving pain

only, not for curative purposes.

+	 Other types of advance care planning

instruments—Include do not

hospitalize or do not send to

emergency department; feeding

restrictions; medication restrictions;

organ donation; and all other advance

care planning requests not otherwise

specified.

Chronic diseases—Usually longterm illnesses that are rarely curable.

Chronic diseases tend to be costly health

conditions that may affect a person’s

ability to function and remain in the

community, and often can lead to death

and disability (17). Chronic conditions

were common among home health care

patients in 2007, both for the primary

admission diagnosis and for all

diagnoses at time of interview.

Dementia—Coded using the

following conditions (ICD–9 codes):

Senile and presenile organic psychotic

conditions (290), other organic psychotic

conditions–chronic (294), and

Alzheimer’s disease (331.0).

Diagnoses—One or more diseases

or injuries in the home health care or

discharged hospice care patient’s

medical record. Diagnoses were

recorded as:

+	 Home health care patients—Primary

diagnosis at admission, primary

diagnosis at time of interview, and up

to 15 secondary diagnoses at time of

interview.

+	 Discharged hospice care

patients—Primary diagnosis at

admission, primary diagnosis at time

of discharge, and up to 15 secondary

diagnoses at time of discharge.

Diagnoses were assigned five-digit

codes, according to the International

Classification of Diseases, 9th Revision,

Clinical Modification (18):

o	 Primary admission diagnosis—

The primary medical condition at

admission, as determined by the

agency respondent who reported

the information from the patient’s

and discharged patient’s medical

record.

o	 Primary diagnosis at interview

and discharge—A primary

diagnosis at the interview for

home health care patients and at

discharge for hospice care

patients. This diagnosis was listed

in the medical record of each

home health care patient or

discharged hospice care patient.

o	 All listed diagnoses at interview

and discharge—Primary and

secondary diagnoses (up to a

maximum of 16) listed in the

medical record of each home

health care patient at interview

and hospice care patient at

discharge.

o	 Average number of all listed

diagnoses at interview and

discharge—All primary and

secondary diagnoses at the

interview for home health care

patients and at discharge for

hospice care patients (up to a

maximum of 16) were averaged.

Emergent care use—Refers to any

rgent, unplanned medical care. This

ncludes services at a hospital

mergency room (including 23-hour

olding); an outpatient department or

linic, including urgent care center sites;

nd a doctor’s office emergency visit or

ouse call. Emergent care use in the 60

ays prior to the interview for home

ealth care patients and discharge for

ospice care patients was measured.

Length of service—The period of

ime from the date of the most recent

dmission to the date of interview (for

ome health care patients) or from the

ate of the most recent admission to the

ate of discharge (for hospice care

atients).

Overnight hospital stay—Refers to

hether a home health care patient had

ad an overnight hospital stay since

dmission to the home health care

gency.

Primary source of payment—The

ingle payment source that paid the

reatest amount of the patient’s charges

t the time of the interview for home

ealth care patients and at discharge for

he hospice care patients. Four

ategories were constructed:

u

i

e

h

c

a

h

d

h

h

t

a

h

d

d

p

w

h

a

a

s

g

a

h

t

c
National Health Statistics Reports

n Number 38n April 27, 2011	 Page 27

+	 Private—Includes private health

insurance, long-term care insurance,

and self-pay by self or family.

+ Medicare—Payment received under

the Medicare program.

+ Medicaid—Payment received under

the Medicaid program.

+ All other sources—Tricare,

Department of Veteran Affairs,

ChampVA, worker’s compensation,

other government, no charge for care,

other source, and payment source not

yet determined.

Service use—Measured using three

broad service types: + Core services (19)—Included skilled

nursing, bereavement, medical or

social, pastoral or spiritual, physician,

dietary, and volunteer services.

+ Noncore services—Included personal

care, homemaker, continuous home

care, respite, and therapeutic

(physical, occupational, and speech or

auditory) services.

(Bereavement, pastoral or spiritual,

dietary, personal care, and respite

services included services received not

only by the discharged hospice care

patient but also his or her family

members or friends.) + Any formal care services—This

included intravenous therapy,

transfusions, tube feeding (including

nasogastric and other enteral

feedings), hyperdermclysis, total

parenteral nutrition or TPN,

respiratory therapy, radiation therapy,

chemotherapy, and palliative sedation.
Page 28 National Health Statistics Reports n Number 38 n April 27, 2011

Suggested citation

Caffrey C, Sengupta M, Moss A, Harris-Kojetin

L, Valverde R. Home health care and

discharged hospice care patients: United

States, 2000 and 2007. National health

statistics reports; no 38. Hyattsville, MD:

National Center for Health Statistics. 2011.

Copyright information

All material appearing in this report is in the

public domain and may be reproduced or

copied without permission; citation as to

source, however, is appreciated.

National Center for Health Statistics

Edward J. Sondik, Ph.D., Director 

Jennifer H. Madans, Ph.D., Associate Director 

for Science 

Division of Health Care Statistics

Jane E. Sisk, Ph.D., Director

U.S. DEPARTMENT OF

HEALTH & HUMAN SERVICES

Centers for Disease Control and Prevention

National Center for Health Statistics

3311 Toledo Road

Hyattsville, MD 20782

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