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), 2006.
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