Hospice Use by Nursing Homes on the Rise, but still Underutilized

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For those who implement an "Aging in Place" plan, hospice plays an integral part in the planning.  First, hospice care is "person-centered care" of the type and kind those who seek to stay home want and need.  Hospice focuses on "palliative care", a specialized type of care focused on relief from the symptoms and stress of a serious illness, with the goal being to enhance or improve the quality of life for both the patient and the family. Second, hospice is a benefit paid for by Medicare, meaning that there is no need for 'spend down," or planned or unplanned indigence to obtain the care.  

Now, according to an article in McKnight's Long-term Care News, more nursing homes are providing hospice care.  The article reported the results of a new LeadingAge report. The Report also finds that hospice care, nonetheless, remains largely underutilized. 

The report notes that the hospices’ prevalence has skyrocketed in recent years, with the number of providers nearly doubling since 2000, at about 4,200 in 2016:

Over the same period of time, the hospice patient population has changed drastically: hospice is now serving more individuals residing in nursing homes and assisted living in addition to its traditional home-based population. In 2016, half of all Medicare hospice beneficiaries died at home and a third died in a nursing home. The terminal conditions experienced by hospice enrollees are also changing. Whereas hospices initially served primarily patients with cancer, they now serve individuals with many different diagnoses, including neurological conditions such as dementia, as well as progressive cardiac and pulmonary diseases [citations omitted]. 

In 2016, about half of all Medicare hospice beneficiaries died at home, while one-third died in a nursing home. Terminal conditions treated by the benefits have changed too. While the service was almost exclusively limited to cancer in the past, patients with dementia and heart disease are increasingly using it, too.

Though hospice use has grown exponentially in recent years, utilization remains low, according to the report. More than one-fourth (28%) of Medicare beneficiaries who used the benefit enrolled for fewer than seven days immediately before death, a length of stay thought to be of less benefit to patients and their families than a longer stay. According to the report, these short stays relate to:

• Physicians being reluctant to discuss hospice or delay such discussions until the patient is close to death;
•  Some patients and families having trouble accepting a terminal prognosis;
• The requirement that patients forego intensive conventional care in order to enroll in hospice; and,
• Financial incentives in fee-for-service Medicare that encourage increased volume of clinical services.

Congress and CMS have introduced a number of initiatives to promote earlier hospice enrollments and better-quality end-of-life care.