Feature Story

Hospice care dramatically reduces end-of-life hospitalizations of nursing home residents

Nursing home residents enrolled in hospice, versus those dying without hospice, are less likely to be hospitalized in the last month of life, concludes a new study. Because of Medicare regulations forbidding acute care hospitalizations for patients enrolled in hospice, hospices often intervene when hospitalization is being considered. This regulation, together with the availability of increased end-of-life palliative care offered by hospice enrollment, appears to be effective in preventing end-of-life hospitalizations, note Brown University School of Medicine researchers, Pedro L. Gozalo, Ph.D., M.Sc. and Susan C. Miller, Ph.D., M.B.A.

They found that 26 percent of hospice and 44 percent of nonhospice nursing home residents were hospitalized in their last 30 days of life. Even after adjusting for confounding factors and selection bias, hospice patients were almost half as likely as nonhospice residents to be hospitalized. Hospice provides an alternative to aggressive curative care. Benefits include better palliative treatment that emphasizes physical, emotional, and spiritual pain relief for the patient and immediate family members.

To become eligible for hospice, a Medicare beneficiary needs to have been certified by the doctor (and the hospice medical director) as having a terminal prognosis of 6 months or less. Furthermore, choosing hospice entails forfeiting access to other Medicare Part A benefits, such as hospitalization and skilled nursing care, for treatment related to the terminal condition, explain the researchers. Their findings were based on analysis of nursing home patient assessment records for 183,742 residents in 5 States, which they linked to the Medicare eligibility file that contains the Medicare beneficiary's date of death. A total of 14,615 residents enrolled in hospice while 169,127 residents did not. The study was supported by the Agency for Healthcare Research and Quality (HS10549 and HS11457).

See "Hospice enrollment and evaluation of its causal effect on hospitalization of dying nursing home patients," by Drs. Gozalo and Miller, in the April 2007 HSR: Health Services Research 42(2), pp. 587-610.

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