The cost of providing end of life care for nursing care home residents: A retrospective cohort study

Background: The proportion of people dying in long-term care institutions is predicted to increase in future years. Establishing the costs associated with the provision of such care is important as it represents a potentially increasing burden. Aim: This study describes the end of life healthcare costs for nursing home residents. The study also explores the effects of resident characteristics on costs, through regression modelling. Setting: This study took place in south-east England. Participants: Thirty-eight nursing care homes took part in the study, comprising 2444 individual residents. Methods: Using a retrospective cohort design, end of life service use was recorded from residents’ nursing care home notes. In this study, end of life was defined as the last six months of life, or from time of residency if this was less than six months. Costs were calculated assuming a healthcare payer perspective. Results: The total mean healthcare cost per resident was £3906. Hospital stays accounted for two-thirds (67%) of these costs. Fifty-six percent of these hospital stays occurred in the final month of life. Death in hospital vs. in the nursing care home was associated with an average increase in costs of £4223. Conclusions: Death in hospital is costly, and is seldom identified as a preferred place of death. Therefore, interventions are needed which help nursing care home staff to identify when an individual is dying, and have the skill and confidence to make difficult decisions regarding care provision at the end of life.