Senior in hospital bed
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Long-term care facility residents and other patients with dementia greatly benefit from hospice services, but that care must be tailored in order to avoid counterintuitively long stays and disenrollment, investigators say.

In a new study, researchers tracked Medicare data from more than 2,000 older adult beneficiaries in the National Health and Aging Trends Study who had died between 2011 and 2017.

About 40% of participants had dementia and 59% of those used hospice care provided in long-term care settings, at home or in a dedicated hospital area or freestanding hospice.

Better ratings

Just over half (52%) of hospice enrollees’ proxies rated residents’ care as excellent, versus 41% of proxies of those who did not have hospice care. What’s more, 67% said residents’ sadness and anxiety was managed when compared with 46% of proxies of non-hospice enrollees.  

Hospice enrollees also were significantly less likely to be switched to a different care setting in the days prior to death (10% were switched) than nonhospice enrollees, 25% of whom were switched. 

Hospice model requires a fix

But the current hospice model does not always work well with the unpredictable nature of dementia, the researchers said. This can result in both reduced access and “paradoxically long stays” for patients, and high rates of disenrollment while they are still alive, researcher Lauren Hunt, Ph.D., RN, of the University of California, San Francisco, said.

Although many people with dementia die from rapidly escalating conditions such as bladder infection or pneumonia, others may be disenrolled because their care often looks nearly the same whether it is months or days before death, Hunt and colleagues said.

For a patient enrolled too early, “disenrollment can feel like abandonment because there are few adequate alternative models of near-death care for people with dementia,” Hunt added.

The study results show that patients with dementia benefit greatly from hospice, but require a more tailored model of care, the authors wrote.

“Future work should examine whether removing prognostic requirements from hospice eligibility for people with dementia positively affects timely access and care quality,” they concluded.

The study was published in the journal Health Affairs.

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