Home Health & Hospice Week

A new study’s title shows what hospices have known all along — “Hospice Improves Care Quality For Older Adults With Dementia In Their Last Month Of Life.”

“Proxies of people living with dementia enrolled in hospice compared with proxies of those not enrolled more often reported care to be excellent (predicted probability: 52 percent versus 41 percent), more often reported having anxiety or sadness managed (67 percent versus 46 percent), and less often reported changes in care settings in the last three days of life (10 percent versus 25 percent),” notes the abstract of the study published in the June 6 issue of the journal Health Affairs.

The findings surprised the researchers from UC San Francisco and Icahn School of Medicine at Mount Sinai. “We honestly expected it not to be positive,” UCSF professor Krista Harrison says in a release about the study. “Since the hospice model was designed for patients with cancer, we expected end-of-life care to be worse for people with dementia.”

The problem: “Eligibility criteria mean that some patients with dementia face hurdles gaining access to hospice or may risk disenrollment,” the release notes.

“Regulatory changes and increased oversight” mean many hospices are reluctant to enroll patients with dementia for more than “brink-of-death care,” for fear they will not be able to document the continuous decline required for eligibility and insurance reimbursement, Harrison says. “The finding that hospice significantly benefits enrollees with dementia underscores the need to ensure access to high-quality end-of-life care for this growing population,” Harrison urges.

The abstract is at https://www.healthaffairs.org/doi/ abs/10.1377/hlthaff.2021.01985.