Research Published in JAMA Raises Concerns about Short Stay Hospice Patients

Categories: Research.

New research from Brown University published in the current issue of the Journal of the American Medical Association finds that use of hospice care among Medicare beneficiaries has risen in the last decade. Yet, concerns about the increasing number of people receiving hospice for three days or less is a call for action.

Findings in the study echo concerns voiced by the National Hospice and Palliative Care Organization that increasing number of short lengths of service may prevent patients and family caregivers from benefiting fully from the range of specialized services and compassionate care that hospices offer.

Additionally, researchers found that the increase of admissions to an Intensive Care Unit, repeated hospitalizations, and multiple transitions in care in the last 90 days of life raises concern about the quality of life for dying elderly Americans.

Researchers, lead by Joan Teno, MD, found hospice use among Medicare beneficiaries increased to 42.2 percent in 2009, up from 21.6 percent in 2000. However, more than 28 percent of these dying individuals received hospice care for three days or less.  Additionally, the proportion of people who had a stay in an Intensive Care Unit in the last month of life increased to 29.2 percent in 2009 from 24.3 percent in 2000.  

“For years the hospice community has been concerned about the growing number of patients who come to hospice within days or hours of dying,” said J. Donald Schumacher, NHPCO president & CEO. “A part of this issue involves patients and families not being aware of the full range of care options available – that would include hospice – when coping with a serious, life-limiting illness.”

NHPCO’s recent Facts & Figures Report (PDF) indicates that 35.7 percent of hospice patients died or were discharged within seven days of admission; while only 11.4 percent of patients were under care for longer than 180 days.
“We must ensure that healthcare providers and families are having clear conversations earlier in the course of an illness about patient  preferences regarding quality of life, where they prefer to receive care, and the type of care they wish to have.  One of the most frequent comments hospice professionals hear from the families they care for is that they wished they  knew about and received hospice earlier,” added Schumacher.

Discussions about palliative care options throughout an illness are necessary as goals of care change as the benefits and burdens of treatments evolve. NHPCO stresses that more timely discussions among families members and then with their healthcare providers might result in earlier access to hospice and reduce the number of difficult transitions in the final months of life.

While even a short period of hospice care might be beneficial for the dying and their loved ones, the Medicare hospice benefit was designed to bring this patient-centered care to people far earlier in the course of an illness.

Access to services hospice offers will also benefit family caregivers by providing necessary support, caregiving training, and help in coping with grief and loss. Support for bereaved family caregivers – integral to hospice palliative care – is often not available in other care settings.

Joan Teno, MD, lead researcher of the study and member of the NHPCO board, stresses the need for physicians and hospitals to focus more on delivering high-quality, patient-centered care that is based on the needs and expectations of an individual approaching the end of life.

The study analyzed Medicare fee-for-service records of more than 840,000 people aged 66 or older who died in 2000, 2005, or 2009.

NHPCO congratulates the research team on this important work and looks forward to continued efforts of Dr. Teno and Brown University that will improve care at the end of life.

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