What Does Hospice Use Look Like in America Today?

What Does Hospice Use Look Like In America Today?

What Does Hospice Use Look Like in America Today?

While the roots of hospice date back centuries, the American hospice industry began in full in 1982 when the federal government launched the first Medicare benefit for hospice. Over time, the diversity of diagnoses seen in hospice has grown steadily. On the other hand, utilization of available services at recommended levels has waxed and waned. What does hospice use look like in America today?

Why Talk About Length of Stay in Hospice?

This question receives annual scrutiny because it is so often out of line with recommended standards of care. Medicare’s hospice benefit offers six months in hospice. Patients can stay in hospice longer when there are extenuating circumstances. Moreover, expert consensus holds that people should receive at least three months in hospice.1,2 Shorter lengths of stay cause patient and family dissatisfaction,3,4 greater patient discomfort,5 worse emotional outcomes for family,6 and increased costs.7 

How Long are Americans Staying in Hospice?

In March 2022, the Journal of Palliative Medicine published some of the latest data for this question. Researcher Melissa Aldridge, PhD, from the Icahn School of Medicine at Mount Sinai, and her colleagues performed a pooled cross-sectional analysis of nationally representative data linked to Medicare claims. How many patients are getting the recommended 90 to 180 days in hospice? The average length of stay in hospice was 83.5 days. That sounds close to the goal until we see that the median length of stay in hospice was only 16 days (just two weeks). The median means you line up all the numbers from smallest to largest, and the median is the one in the middle. In other words, half of patients received hospice for about two weeks or less.

Are Hospice Stays Too Short or Too Long?

Hospice stays are too short. Occasionally, legislators and inspectors want to focus on agencies that sometimes provide hospice for longer than six months. This happens with 15% of patients. However, one out of five patients receive hospice for three days or less. Short hospice stays are more common, more costly than long hospice stays in terms of overall healthcare spending, and are far worse for patients and families.

How Common is Hospice Disenrollment?

Fifteen percent of hospice patients discharge from hospice alive. This happens for various reasons. Some patients have improved health conditions and no longer qualify for hospice. Nurses sometimes refer to these patients as “hospice graduates.” 

What Are the Most Common Diagnoses in Hospice?

In years past, hospice was primarily associated with cancer. Today, hospice takes care of patients with a diverse range of terminal conditions.

  • Cancer: 31.3%
  • Dementia: 14.9%
  • Heart failure: 10%
  • Lung disease: 9.3%
  • Other: 35.4%

Size of the Hospice Industry

The number of Medicare-certified hospice agencies has grown steadily over the years. In 2012, there were 5,560 sites (including satellite offices) and 3,950 Medicare-certified agencies. The last count in 2019 totaled 4,800 Medicare-certified hospice agencies.     

References

  1. Teno J, Shu J, Casarett D, et al Timing of referral to hospice and quality of care: Length of stay and bereaved family member’s perceptions of the timing of hospice referral. Journal of Pain and Symptom Management. 2007; 34: 120-125.
  2. Rickerson E, Harrold J, Kapo J, et al. Timing of hospice referral and families’ perceptions of services. Are earlier hospice referrals better? Journal of the American Geriatric Society. 2005; 53: 819-823.
  3. Schockett E, Teno J, Miller S. Late referral to hospice and bereaved family member perception of quality of end-of-life care. Journal of Pain and Symptom Management. 2005; 30: 400-407.
  4. Miceli P, Mylod D. Satisfaction of families using end-of-life care: Current successes and challenges in the hospice industry. American Journal of Hospice and Palliative Care. 2003; 20: 360-370.
  5. Cheraghlou S, et al. Restricting symptoms before and after admission to hospice. The American Journal of Medicine. 129: 754.e7 – 754.e15.
  6. Bradley EH, Prigerson H, Carlson MD, Cherlin E, Johnson-Hurzeler R, Kasl SV. Depression among surviving caregivers: does length of hospice enrollment matter?. American Journal of Psychiatry. 2004 Dec 1;161(12):2257-62.
  7. Hamano J, Yamaguchi T, Maeda I, et al. Multicenter cohort study on the survival time of cancer patients dying at home or in a hospital: Does place matter? Cancer. 2016 May; 122 (9): 1453-60.
  8. Hamano J, Yamaguchi T, Maeda I, et al. Multicenter cohort study on the survival time of cancer patients dying at home or in a hospital: Does place matter? Cancer. 2016 May; 122 (9): 1453-60.
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