JOURNAL OF PALLIATIVE MEDICINE Volume 9, Number 6, 2006 © Mary Ann Liebert, Inc. Hospice Attitudes among Assisted Living and Nursing Home Administrators, and the Long-Term Care Hospice Attitudes Scale DEBRA JEAN DOBBS, Ph.D., 1 LAURA HANSON, M.D., M.P.H., 2 SHERYL ZIMMERMAN, Ph.D., 3 CHRISTIANNA S. WILLIAMS, Ph.D., 3 and JEAN MUNN, Ph.D. 4 ABSTRACT Objectives: To examine the attitudes of residential care/assisted living (RC/AL) and nursing home (NH) administrators toward hospice and to assess facility and administrator character- istics related to those attitudes. Design: Two exploratory factor analyses of the Hospice Attitudes Questionnaire using prin- cipal factors with a promax (oblique) rotation were conducted. One was in a sample of 390 RC/AL and NH administrators from four states (Florida, Maryland, North Carolina, and New Jersey) and the other included NHs from this and a second sample (n  244). Association be- tween facility and administrator characteristics and administrator attitudes towards hospice were examined among the 146 RC/AL administrators. Results: Exploratory factor analysis in the full sample resulted in the 12-item Long-Term Care Hospice Attitudes Scale (LTC-HAS) with four component subscales: (1) emotional and spiritual support (three items,   0.83); (2) quality of care (four items,   0.78); (3) rapidity of death (three items,   0.66) and (4) end-of-life care coordination (two items,   0.73). The overall alpha for the 12-item scale was 0.81. When exploratory factor analysis was conducted on the NH data only, a three-item subscale related to financing and billing (  0.66) also emerged. Four facility and three administrator characteristics that were significantly related to hospice attitudes included state, facility type, facility age, affiliation with another level of care; and age, race, and nurse training. Conclusion: Findings from this paper provide insight about RC/AL facility and NH ad- ministrators’ attitudes towards Hospice using scale data, an area with limited research. They indicate positive attitudes toward Hospice care coordination, and that Hospice should sup- plement, as opposed to replace, the care provided by facilities. Findings also suggest areas where targeted outreach and further study may be recommended. INTRODUCTION A SIGNIFICANT AMOUNT of end-of-life (EOL) care is provided in long-term care (LTC) settings. More than 1.7 million older adults live in nurs- ing homes (NHs), where the annual mortality rate is 24%–32%. 1,2 Almost 1 million older adults live in residential care/assisted living (RC/AL) set- tings, one third of whom remain until death, 3,4 and for whom annual mortality rates are between 1 University of South Florida, School of Aging Studies, University of South Florida, Tampa, Florida. 2 School of Medicine, 3 Sheps Center for Health Services Research, 4 School of Social Work, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina. 1388