Nursing-Home Hospice Care Reduces End-of-Life Hospitalizations

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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.

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