In an article published by The Washington Post, “For end-stage dementia, Medicare can make hospice harder to access,” (03/26/22), journalist Emily Harris explores the challenges patients with advanced dementia may encounter when accessing hospice care under the Medicare hospice benefit.
Harris reports, “Based on a recent study, Medicare’s hospice regulations are not working as intended for many people with dementia, says Elizabeth Luth, a sociologist at Rutgers University who studies end-of-life care. According to her study of 3,837 hospice patients with dementia, about 5 percent are pulled from hospice when their condition seems to have stabilized. Plus, the number of Americans over 65 with dementia is projected to more than double to 13.8 million by 2060. Many will need hospice care.”
Patients with an advanced dementia diagnosis are often deemed eligible for hospice care under the requirements of the Medicare hospice benefit but their condition can often stabilize once receiving the person-centered, interdisciplinary team support and services that hospice makes available. They are then disenrolled from hospice for failing to meet the eligibility requirements that originally afforded them access to care. The article in The Washington Post shares examples of how this can go on for years until a person’s death.
The changing face of hospice patients is reflected in the Facts and Figures Report released by the National Hospice and Palliative Care Organization. This report provides an overview of hospice care delivery in the U.S., with specific information on hospice patient characteristics, location and level of care, Medicare hospice spending, hospice provider characteristics, and more. A key point from the current report notes that in 2019 there was continued growth in the number of Medicare hospice patients with non-cancer diagnoses, including a principal diagnosis of Alzheimer’s, dementia, or Parkinson’s, which represented more than four times the number of patients who had cancer. For several decades, hospices primarily served people with cancer diagnoses. As recently as 2007, cancer continued to be the leading principal diagnosis of those receiving care. However, that has shifted dramatically over the last decade.
“In the nearly forty years that the Medicare hospice benefit has been in place, we’ve seen a significant shift in the primary diagnoses, how communities access care, length of service, and how hospice is made available,” said NHPCO President and CEO Edo Banach. “The latest NHPCO Facts and Figures report is a resource for policymakers and healthcare leaders nationwide who are mapping the future of patient-centered, interdisciplinary care to help patients live life to its fullest right up to the end.”
NHPCO is advocating for changes to ensure people get the care they want, including: defining a Medicare benefit for community-based palliative care; calling for concurrent care demonstration allowing for the provision of palliative care services and hospice care under Medicare; and reevaluating six month diagnosis rule needed to qualify for hospice.
The recent Washington Post article quotes health services researcher and former hospice medical director Joan Teno, “We need to update the payment models, and especially hospice, to really reflect this changing disease trajectory of an aging society. What I’d rather see is some flexibility.”
Find the article on The Washington Post website: https://www.washingtonpost.com/health/2022/03/26/medicare-alzheimers-dementia-hospice/.