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Long-term Care

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When integrated into nursing home care, hospice care decreases hospitalizations for Medicare patients

More than one in five older people die in a nursing home. Often, inappropriate and traumatic hospitalizations diminish the quality of life of these patients. Legislation provides for Medicare hospice care in nursing homes to provide comfort care by contracted hospice providers. This integration of hospice care into nursing home care reduces hospitalizations among dying nursing home patients, according to a study supported in part by the Agency for Healthcare Research and Quality (HS10549).

Researchers from Brown University studied hospitalizations for Medicare nursing home residents in five States who had enrolled in hospice care between 1992 and 1996 and who died before 1998. They compared hospitalizations of 9,202 Medicare hospice residents with 27,500 nonhospice residents with similar lengths of nursing home stays.

The goal of hospice care is to alleviate symptoms, reduce unneeded and unwanted medical intervention, and attend to the psychosocial needs of patients and families. Overall, 24 percent of hospice and 44 percent of nonhospice residents were hospitalized in the last month of life. Nonhospice residents also benefited from being in homes with hospice care, probably due to diffusion of the palliative care philosophy and practices associated with hospice. Compared with residents in facilities with no hospice, hospitalization was 18 percent less likely for nonhospice residents in facilities with low hospice use and 29 percent less likely for those in facilities with moderate hospice use (defined as 5 percent or more patients in hospice).

Although the hospice Medicare benefit does have a hospice inpatient option, it was infrequently used, accounting for only 3 percent ($77 of $2,296) of all per patient hospice expenditures in the last 30 days of life. The researchers conclude that Medicare dollars saved with reduced hospitalizations may offset any increased Medicare costs associated with long-stay hospice patients, as well as improve the quality of life of dying nursing home patients.

More details are in "Hospice enrollment and hospitalization of dying nursing home patients," by Susan C. Miller, Ph.D., Pedro Gozalo, Ph.D., and Vincent Mor, Ph.D., in the July 2001 American Journal of Medicine 111, pp. 38-44.

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