Hospice Situation Analysis

Current Statistics
Length of Stay The amount of time an individual receives services prior to their death, or prior discharge from hospice services, is referred to as their length of stay. Several factors influence a patient’s length of stay including timing of the referral, access to care, and disease course (NHPCO, 2015b). In addition, hospice regulations state an individual must have a prognosis of death within six months or less. Nonetheless, it is difficult to predict the exact time of death for most diseases, this causes some doctors to overestimate or underestimate the amount of time a patient has left. Subsequently, the length of stay of patients vary. According to the 2015 NHPCO report, 50.3% of patients died or were discharged within
14 days of admission in 2014. Furthermore, 34.5% of patients’ length of stay was 7 days or less. Unfortunately, most research supports this amount of time is too short for an individual and their family to benefit from the services hospice provides (Daugherty & Steensma, 2002).
Location of Services The initial intent of hospice was to allow for end-of-life care to occur in private homes (Jennings et al., 2003).
Today, services are provided in home, at nursing homes, residential facilities, hospice inpatient facilities, and acute care hospitals (NHPCO, 2015b). According to the 2015 NHPCO annual study, the majority of individuals receive hospice care in private homes. The second most common place for individuals to receive hospice care were inpatient hospice facilities. According to the NHPCO study in 2015, 1 in 3 hospice providers have their own inpatient facilities. These facilities usually attempt to resemble a private home to make the patients and their families feel as comfortable as possible. Individuals attend these facilities when symptoms have become too difficult to manage at home, or when a caregiver needs respite (NHPCO,
2015b).
Primary Diagnosis The primary diagnosis of the majority of patients in hospice has also changed throughout the years. Initially, the majority of patients who utilized these services had a primary diagnosis of cancer (Jennings et al., 2003). The first year cancer was not the main diagnosis of hospice patients was 2005 (Vitez, 2006). From this point forward, the majority of patients being cared for by hospice providers had a primary diagnosis of heart disease, neurological disorders, or lung disease. According to the most recent report conducted by the NHPCO 63.4% of individuals are non-cancer patients. Approximately 14.8% had dementia, 14.7% had heart disease, 9.3% had lung disease, and 8.3% had another disease (NHPCO, 2015b). With the abundance of new treatments for cancer, the amount of hospice patients with the primary diagnosis of cancer is projected to continue to decrease (Daugherty & Steensma, 2002).
Demographics
The demographical characteristics of the individuals who utilize hospice services have remained relatively consistent throughout the years (NHPCO, 2015b).
The majority of hospice patients were female in 2014. The age of the individuals entering hospice vary, however, the majority of individuals are 75 years of age and older. Less than 1% of individuals receiving hospice care in 2014 were 34 years and younger. Since the beginning of hospice care in the United States the primary race of patients who received services were Caucasian. This remains true today, approximately 76% of individuals receiving services are white (NHPCO, 2015b). Multiple factors have attributed to the discrepancy in ethnicities utilizing hospice services. These factors include cultural and religious views regarding death and after-life beliefs, general access to health care services, and knowledge of available health care services (Hospice Associations of America [HAA], 2010). For example, a study found African American families believe it is a sign of respect to pursue more aggressive treatments for their loved ones. They believe it is up to God to determine the right time for death (Dula et al., 2005). Despite these differences, hospice care has proven to be beneficial for individuals of all ethnicities (Jennings et al.,
2003).
Financial Statistics Today hospice services are covered under Medicare, most private insurances, and the majority of Medicaid programs (NHPCO, 2015b). As discussed earlier, Congress passed legislation that allowed hospice services to be covered under Medicare in 1982. Since then, the primary payer for hospice services has been Medicare (Cerminara, 2010). In the year of 2014, 85.5% of services were covered by Medicare, 6.9% of services were covered by private insurance, 6.2% was covered by Medicaid, and the remaining services were covered by charity, self pay, or another payment source. The government has established they will conduct studies in the near future to further assess the financial benefit of hospice services (Patient Protection and Affordable Care Act, 2010).
Benefits of Hospice Multiple studies have been conducted to provide evidence to support the plethora of benefits hospice provides for the terminally ill and their families. These benefits include: continuity of care; access to healthcare professionals 24 hours a day, 7 days a week; decrease in hospitalizations; and access to bereavement services. Singer, Bachner, Schvartzman, and Carmel (2005) found 80.3% of individuals who received hospice care were able to die in their home, while only 20.5% of the non-hospice patients were able to die at home. Furthermore, this study found the family satisfaction of end-of-life care was 90% for those who participated in hospice services. Only 61% of families who did not participate in hospice were satisfied with the end-of-life care their loved one received (Singer, Bachner, Schvartzman, & Carmel, 2005). Teno et al. (2004) found family satisfaction of the staff’s attentiveness to the patient’s level of pain and need for emotional support was much higher than families who did not participate in hospice. In addition, a systematic review of quantitative and qualitative evidence of the benefits of hospice treatment found patients felt less isolated, and families and caregivers felt more supported with hospice care than those who did not receive hospice services (Candy et al., 2011). Another study showed families who participated in hospice services and experienced a loss of a loved one 2 years ago showed better psychological functioning than families who did not participate in hospice services (Ragow-O’brien, 2000).
Fiscally, hospice saves both the grieving families and Medicare a substantial amount of money. A study conducted in 1988 found for every $1.00 spent on hospice care, Medicare saved $1.26 (Kiddler, 1992). Furthermore, a study conducted by Duke University found on average each patient who utilized hospice services saved Medicare $2,309 in the last year of life. In addition, they found the most fiscal benefits were provided by those individuals who utilized hospice services in the last 50-108 days of life (Traylor et al., 2007). Unfortunately, statistics show the majority of patients do not enter hospice care until the last few weeks of their lives (NHPCO, 2015b). Therefore, families and Medicare are not reaping the full potential financial benefits from hospice care.