Any hospice better than none at end of life

By Sarah Guy, medwireNews Reporter

Nursing home (NH) residents with advanced dementia who receive any hospice care during the last 90 days of life receive fewer aggressive treatments and are less likely to die in hospital than their counterparts who do not receive such care, show US study results.

Medicare policy states that patients in this population cannot receive skilled nursing facility (SNF) care and hospice care for the same terminal condition, note the researchers.

However, the current results "lend plausible support to the notion that dual access to Medicare SNF and hospice care may reduce rates of end-of-life hospitalizations," remarks the team in the Journal of the American Geriatrics Society.

Susan Miller (Brown University, Providence, Rhode Island) and colleagues reviewed data on 4344 NH patients with advanced dementia who died during 2005 to 2006 and had received Medicare SNF care in the 3 months before death.

Of these patients, 1086 also received hospice care after (65%) or alongside (35%) SNF care, either for a separate condition or paid for out-of-pocket.

Patients who received any hospice care after SNF care received significantly fewer medications and therapies, and had intravenous fluids, feeding tubes, and/or intramuscular medication injections significantly less frequently than their peers who did not receive hospice care, report Miller et al.

Furthermore, rates of hospital death were significantly lower among patients who received any hospice care compared with those who did not, at 2.4% and 0.4% among those who received it alongside or after SNF care, respectively, versus 21.3%.

Indeed, the likelihood of dying in a hospital was a significant 98% and 87% lower among those who received hospice care after or alongside SNF, respectively, compared with those who received no hospice care.

Puzzlingly, the researchers note that patients with concurrent hospice and SNF care were 65% more likely to have had persistent pain than their counterparts without hospice care. However, "it is likely that the outcome measure lacked the sensitivity to adequately capture changes that may occur with hospice enrollment," they remark.

"Through the Affordable Care Act's required Medicare Hospice Concurrent Care demonstration project (which will allow concurrent hospice and other Medicare Part A care), the benefits and costs of concurrent Medicare SNF and hospice care will be studied," the team concludes.

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