Hospice Group Says JAMA Report on Last Minute Use of
Hospice Care is Call for Action
NHPCO calls for earlier and more frequent
conversations between patients and healthcare professionals
6, 2013 Research published yesterday in JAMA found the rate of hospice
use doubled from 2000 to 2009 but 28 percent of these dying Medicare
patients used the service three days or less. This is a call for
action, says a statement from the
and Palliative Care Organization.
Findings in the study from Brown University echo
concerns voiced by the
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.
Researchers also 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.
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
Researchers 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
Facts & Figures
Report 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," added
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.
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.
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.