Eli's Hospice Insider

Average length of service holds steady at 69 days.

Hospice use is on the rise in the United States. 2009 saw an increase in hospice utilization with an estimated 1.56 million patients receiving services, according to the National Hospice and Palliative Care Organization's (NHPCO) 2010 facts and figures report on hospice care in America.

The 1.56 million patients break down into three categories:

• 1,020,00 patients who died under hospice care in 2009
• 294,000 who remained on the hospice census at the end of 2009 (known as "carryovers")
• 243,000 patients who were discharged alive in 2009 for reasons including extended prognosis, desire for curative treatment, and other reasons (known as "live discharges").

2,450,000 Americans died in 2009, according to the Centers for Disease Control and Prevention. Of those, the NHPCO estimates that 1,020,000 or 41.6 percent occurred under the care of a hospice program. This is an increase from 38.8 percent in 2008 and 35 percent in 2007, the NHPCO said in a press release. "This rising statistic shows that more Americans facing a life-limiting illness are opting for care that addresses medical, emotional, and spiritual needs at the end of life," said J. Donald Schumacher, NHPCO president and CEO in the release.

Research studies continue to show that hospice patients live longer than those who don't receive hospice care. The NHPCO report points to a study published recently in the New England Journal of Medicine which found that lung cancer patients who received early palliative care lived 23.3 percent longer than those who delayed such treatment. (Note: See related story on page 75.) Patients in the NEJM-reported study who received early palliative care lived an average of 2.7 months longer than those who had standard care. The study authors theorized that patients receiving early hospice care "may receive care that results in better management of symptoms, leading to stabilization of their condition and prolonged survival." This new study further underscores hospice care's positive impact, following a 2007 study which concluded that hospice and palliative care may prolong the lives of some terminally ill patients, the NHPCO points out. The 2007 study found that hospice patients lived an average of 29 days longer than their non-hospice peers. Patients in four out of the six disease categories studied experienced this longer length of survival, with congestive heart failure patients gaining the most -- 402 days compared to 321. Other disease categories for which hospice appeared to increase length of survival were lung cancer, pancreatic cancer, and colon cancer.

Cancer was the diagnosis that made up the greatest percentage of hospice admissions in the 1970s when hospice care first began in the United States, the NHPCO report notes. Currently, less than half (40.1 percent) of all hospice admissions are due to a cancer diagnosis. The top four non-cancer primary diagnoses for patients admitted to hospice in 2009 were debility unspecified (13.1 percent), heart disease (11.5 percent), dementia (11.2 percent), and lung disease (8.2 percent).

The average length of service for hospice patients kept steady at 69 days, the NHPCO found. Median length of service also held steady at 21.1 days. In other words, half of all hospice patients received care for less than three weeks and the other half received care for more than three weeks.

Other findings in the report include:

• Routine home care accounted for 95.9 percent of patient care days.

The majority of hospice care (68.8 percent) was provided in the home, which could be a private residence, nursing home, or residential facility.

Note: Read the full NHPCO report here: www.nhpco.org/files/public/Statistics_Research/Hospice_Facts_Figures_Oct-2010.pdf