Nursing Home Hospice Care Reduces End-of-Life
Hospitalization :
Nursing-home residents in hospice care have about
half the chance of being admitted to a hospital in
their last 30 days of life compared to peers who
don't receive hospice care, a large new study
confirms.
“Our study provides strong evidence that access to
hospice in nursing homes significantly reduces
hospitalization,” said study author Pedro Gozalo,
Ph.D.
Gozalo and co-investigator Susan Miller, Ph.D., of
Brown Medical School, examined data from 183,742
nursing home residents in five states. The
retrospective study is published online in Health
Services Research.
People who choose hospice, which focuses on comfort
instead of cure, tend to refuse aggressive
end-of-life treatment anyway, Gozalo said. But even
taking this into consideration, hospice still makes
a significant difference in keeping people out of
the hospital in their last days, the study shows.
The study also looked at characteristics of nursing
home residents who receive hospice care. They are
more likely to have a cancer diagnosis, although
“two-thirds of nursing- home residents in hospice
have a noncancer diagnosis,” Gozalo said. Hospice
patients are also more likely to be female, white
and married compared to residents not receiving
hospice care.
Other factors, such as nursing-home location, also
influence enrollment in hospice. For example,
nursing homes with hospice providers farther than 15
miles away had fewer residents using these services.
In addition, enrollment in hospice varies widely
from state to state.
Hospitalizing a terminally ill patient may
negatively affect that person's remaining quality of
life. From an economic standpoint, such
hospitalizations can result in large and unwarranted
expenditures.
“About 80 percent of nursing homes now have
arrangements to provide hospice care,” Gozalo said,
but that doesn't mean access is a given. Failing to
identify residents who need hospice, financial
incentives for nursing homes to keep providing
skilled care and local health system policy may
affect access to hospice services, Miller said.
Susan Mitchell, M.D., an associate professor at
Harvard Medical School, said, “Families of nursing
home residents need to know hospice is an option and
that their loved one is entitled to the Medicare
hospice benefit. They can request hospice from the
doctor or social worker. They can also contact a
hospice provider themselves,” if the nursing home
does not offer hospice care, Mitchell said.
The study was funded by a grant from the Agency of
Healthcare Research and Quality, U.S. Department of
Health and Human Services.
Health Services Research is the official
journal of the AcademyHealth and is published by
Blackwell Publishing on behalf of the Health
Research and Educational Trust. For information,
contact Jennifer Shaw, HSR Business Manager at (312)
422-2646 or jshaw@aha.org. HSR is available online
at http://www.blackwell-synergy.com/loi/hesr. Gozalo
P, Miller S. Hospice enrollment and evaluation of
its causal effect on hospitalization of dying
nursing home patients. Health Services Research
(online), 2012.
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