Hospice benefit should be redesigned with nursing home residents in mind, researcher says

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Medicare policy should change to better support nursing home residents who need hospice care, say investigators at the Regenstrief Institute and the Indiana University Center for Aging Research. They have been studying the characteristics of nursing home hospice patients, and announced their findings Tuesday.

Those receiving care in a nursing home have a longer average hospice stay than those living in a community setting, the investigators determined. They also are more likely to be women, be dually eligible for Medicare and Medicaid and have dementia.

The need to support hospice care in nursing homes can be seen as even more pressing when another group is considered: Those who use hospice care both in a nursing home and a community setting. Nearly a third of this group received hospice services for longer than six months, the study authors found, while hospice length-of-stay was shorter than one week for about a third of patients overall.

“Hospice is a poor fit for many people in nursing homes due to the way eligibility criteria currently are configured,” lead researcher Kathleen Unroe, M.D., stated in a press release. “Yet nearly a third of hospice patients in the United States live in nursing homes, and the number is growing. Our goal is to understand more about who uses hospice and where they live so that policymakers can make informed decisions as they contemplate redesign of the hospice benefit.”

The findings are based on 11 years of data for more than 3,700 patients of the Eskenazi Health (formerly Wishard Health Services) system.

Full findings are forthcoming in the Journal of General Internal Medicine.