Frequency and Risk Factors for Live Discharge from Hospice

Russell, David; Diamond, Eli L.; Lauder, Bonnie; Dignam, Ritchell; Dowding, Dawn; Peng, Timothy R.; Prigerson, Holly G.; Bowles, Kathryn H.

doi:10.1111/jgs.14859

Cited by 50 publications

(65 citation statements)

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“…Roughly 20% of hospice patients experience live discharge from hospice before death . Live discharge is frequently a burdensome and disruptive transition for patients and their family members, who may lose services and support they have come to depend on such as nursing, social work, home health aides, and spiritual care .…”

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confidence: 99%

“…African American and Hispanic individuals, however, are less likely to enroll in hospice than non‐Hispanic whites . When they do enroll, they are more likely to be disenrolled . African Americans are less likely to reenroll in hospice after experiencing a live discharge .…”

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confidence: 99%

“…Many studies have examined characteristics associated with live discharge among patients from the general hospice population . However, less is known about how demographic and health characteristics related to risk for live discharge are due to condition stabilization in PWD.…”

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confidence: 99%

“…This study aims to (1) identify demographic and health correlates of live discharge due to condition stabilization in PWD, and (2) explore how hospice service delivery factors relate to this live discharge type in PWD. We focus on live discharge due to condition stabilization because of its particular importance in PWD, whose odds of experiencing this disenrollment type are more than 13 times greater than for patients with cancer . We use a sample of hospice PWD who did not die within 7 days of enrollment and did not exceed the initial 6‐month period for which the Medicare hospice benefit is intended.…”

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confidence: 99%

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Race, Ethnicity, and Other Risks for Live Discharge Among Hospice Patients with Dementia

Luth

Russell

Brody

et al. 2019

J American Geriatrics Society

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OBJECTIVES The end‐of‐life trajectory for persons with dementia is often protracted and difficult to predict, placing these individuals at heightened risk of live discharge from hospice. Risks for live discharge due to condition stabilization or failure to decline among patients with dementia are not well established. Our aim was to identify demographic, health, and hospice service factors associated with live discharge due to condition stabilization or failure to decline among hospice patients with dementia. DESIGN Retrospective cohort study. SETTING A large not‐for‐profit agency in New York City. PARTICIPANTS A total of 2629 hospice patients with dementia age 65 years and older. MEASUREMENTS Primary outcome was live discharge from hospice due to condition stabilization or failure to decline (vs death). Measures include demographic factors (race/ethnicity, Medicaid, sex, age, marital status, parental status), health characteristics (primary dementia diagnosis, comorbidities, functional status, prior hospitalization), and hospice service (location, length of service, number and timing of nurse visits). RESULTS Logistic regression models indicated that compared with white hospice patients with dementia, African American and Hispanic hospice patients with dementia experienced increased risk of live discharge (African American: adjusted odds ratio [aOR] = 2.42; 95% confidence interval [CI] = 1.34‐4.38; Hispanic: aOR = 2.99; 95% CI = 1.81‐4.94). Home hospice (aOR = 7.57; 95% CI = 4.04‐14.18), longer length of service (aOR = 1.04; 95% CI = 1.04‐1.05), and more days between nurse visits and discharge (aOR = 1.86; 95% CI = 1.56‐2.21) were also associated with live discharge. CONCLUSION To avoid burdensome and disruptive transitions out of hospice in patients with dementia, interventions to reduce live discharge due to condition stabilization or failure to decline should be tailored to meet the needs of African American, Hispanic, and home hospice patients. Policies regarding sustained hospice eligibility should account for the variable and protracted end‐of‐life trajectory of patients with dementia. J Am Geriatr Soc 68:551–558, 2020

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confidence: 99%

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confidence: 99%

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confidence: 99%

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confidence: 99%

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Race, Ethnicity, and Other Risks for Live Discharge Among Hospice Patients with Dementia

Luth

Russell

Brody

et al. 2019

J American Geriatrics Society

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“…Patients in hospice with a diagnosis of dementia have been found to have significantly longer duration of hospice care likely due to the difficulty of prognostication for those with a primary diagnosis of dementia compared with other diseases. 30 We also found, however, that half of all patients with a primary diagnosis of dementia who disenrolled from hospice died within 5 months of hospice disenrollment, suggesting that the Medicare Hospice Benefit may not be the right fit for people with dementia. 7 Home-based palliative care models outside of the Medicare Hospice Benefit that do not require a predictable terminal prognosis may better align with the needs of those with a primary diagnosis of dementia who desire home-based palliative care.…”

Section: Discussionmentioning

confidence: 69%

Hospice Care for Patients With Dementia in the United States: A Longitudinal Cohort Study

Vleminck

Morrison

Meier

et al. 2018

Journal of the American Medical Directors Association

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Background Patients with dementia form an increasing proportion of those entering hospice care. Little is known about the types of hospices serving patients with dementia and the patterns of hospice use, including timing of hospice disenrollment between patients with and without dementia. Objectives To characterize the hospices that serve patients with dementia, to compare patterns of hospice disenrollment for patients with dementia and without dementia, and to evaluate patient-level and hospice-level characteristics associated with hospice disenrollment. Methods We used data from a longitudinal cohort study (2008–2011) of Medicare beneficiaries (n = 149,814) newly enrolled in a national random sample of hospices (n = 577) from the National Hospice Survey and followed until death (84% response rate). Results A total of 7328 patients (4.9%) had a primary diagnosis of dementia. Hospices caring for patients with dementia were more likely to be for-profit, larger sized, provide care for more than 5 years, and serve a large (>30%) percentage of nursing home patients. Patients with dementia were less likely to disenroll from hospice in conjunction with an acute hospitalization or emergency department visit and more likely to disenroll from hospice after long enrollment periods (more than 165 days) as compared with patients without dementia. No significant difference was found between patients with and without dementia for disenrollment after shorter enrollment periods (less than 165 days). In the multivariable analyses, patients were more likely to be disenrolled after 165 days if they were served by smaller hospices and hospices that served a small percentage of nursing home patients. Conclusion Patients with dementia are significantly more likely to be disenrolled from hospice following a long enrollment period compared with patients without dementia. As the number of individuals with dementia choosing hospice care continues to grow, it is critical to address potential barriers to the provision of quality palliative care for this population near the end of life.

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Hospice Readmission, Hospitalization, and Hospital Death Among Patients Discharged Alive from Hospice

Luth,

Brennan,

Hurley

et al. 2024

JAMA Netw Open

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ImportanceTransitions in care settings following live discharge from hospice care are burdensome for patients and families. Factors contributing to risk of burdensome transitions following hospice discharge are understudied.ObjectiveTo identify factors associated with 2 burdensome transitions following hospice live discharge, as defined by the Centers for Medicare &amp; Medicaid Services.Design, Setting, and ParticipantsThis population-based retrospective cohort study included a 20% random sample of Medicare fee-for-service beneficiaries using 2014 to 2019 Medicare claims data. Data were analyzed from April 22, 2023, to March 4, 2024.ExposureLive hospice discharge.Main Outcomes and MeasuresMultivariable logistic regression examined associations among patient, health care provision, and organizational characteristics with 2 burdensome transitions after live hospice discharge (outcomes): type 1, hospice discharge, hospitalization within 2 days, and hospice readmission within 2 days; and type 2, hospice discharge, hospitalization within 2 days, and hospital death.ResultsThis study included 115 072 Medicare beneficiaries discharged alive from hospice (mean [SD] age, 84.4 [6.6] years; 71892 [62.5%] female; 5462 [4.8%] Hispanic, 9822 [8.5%] non-Hispanic Black, and 96 115 [83.5%] non-Hispanic White). Overall, 10 381 individuals (9.0%) experienced a type 1 burdensome transition and 3144 individuals (2.7%) experienced a type 2 burdensome transition. In adjusted models, factors associated with higher odds of burdensome transitions included identifying as non-Hispanic Black (type 1: adjusted odds ratio [aOR], 1.47; 95% CI, 1.36-1.58; type 2: aOR, 1.70; 95% CI, 1.51-1.90), hospice stays of 7 days or fewer (type 1: aOR, 1.13; 95% CI, 1.06-1.21; type 2: aOR, 1.71; 95% CI, 1.53-1.90), and care from a for-profit hospice (type 1: aOR, 1.78; 95% CI, 1.62-1.96; type 2: aOR, 1.32; 95% CI, 1.15-1.52). Nursing home residence (type 1: aOR, 0.66; 95% CI, 0.61-0.72; type 2: aOR, 0.47; 95% CI, 0.40-0.54) and hospice stays of 180 days or longer (type 1: aOR, 0.63; 95% CI, 0.59-0.68; type 2: aOR, 0.60; 95% CI, 0.52-0.69) were associated with lower odds of burdensome transitions.Conclusion and RelevanceThis retrospective cohort study of burdensome transitions following live hospice discharge found that non-Hispanic Black race, short hospice stays, and care from for-profit hospices were associated with higher odds of experiencing a burdensome transition. These findings suggest that changes to clinical practice and policy may reduce the risk of burdensome transitions, such as hospice discharge planning that is incentivized, systematically applied, and tailored to needs of patients at greater risk for burdensome transitions.

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Frequency and Risk Factors for Live Discharge from Hospice

Cited by 50 publications

References 40 publications

Race, Ethnicity, and Other Risks for Live Discharge Among Hospice Patients with Dementia

Race, Ethnicity, and Other Risks for Live Discharge Among Hospice Patients with Dementia

Hospice Care for Patients With Dementia in the United States: A Longitudinal Cohort Study

Hospice Readmission, Hospitalization, and Hospital Death Among Patients Discharged Alive from Hospice

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