What length of hospice use maximizes reduction in medical expenditures near death in the US Medicare program?

Taylor, Donald H.; Ostermann, Jan; Houtven, Courtney Harold Van; Tulsky, James A.; Steinhauser, Karen E.

doi:10.1016/j.socscimed.2007.05.028

Cited by 183 publications

(163 citation statements)

References 21 publications

Supporting

Mentioning

152

Contrasting

Order By: Relevance

“…The mean length of stay for the more than 1.3 million patients who received hospice services in 2006 was 59 days, and the median length of stay was only 20.6 days. 15 Nearly half of the patients enrolled in hospice have cancer as a primary diagnosis, and only 12.2% have a primary diagnosis of cardiac disease. 16 Nonhospice palliative medicine is aimed at improving quality of life and supporting patients and the families of patients with serious and complex chronic illnesses in whom prognosis is uncertain or may be measured in years.…”

Section: Overview Of Palliative Carementioning

confidence: 99%

Palliative Care in the Treatment of Advanced Heart Failure

et al. 2009

View full text Add to dashboard Cite

H eart failure is epidemic in developed countries and is expanding rapidly worldwide. Roughly 5% of patients with heart failure have end-stage disease that is refractory to medical therapy (stage D heart failure). 1 Palliative care consultation relieves symptoms, improves patient satisfaction, and decreases the costs of care for these patients. Despite this, only a small fraction of end-stage heart failure patients receive palliative care consultation. In recognition of this, palliative/hospice care referral was recommended for endstage heart failure (Level of Evidence 1A) in the most recent American College of Cardiology/American Heart Association heart failure guidelines. 2 To identify evidence-based studies of palliative care in heart failure, we searched the Medline database for literature with the medical subject headings "heart failure" and "palliative care," "supportive care," or "symptom management" and found 394 results. We identified 92 systematic reviews, 44 of which were English-language systematic reviews published within the past 5 years.

show abstract

Section: Overview Of Palliative Carementioning

confidence: 99%

Palliative Care in the Treatment of Advanced Heart Failure

et al. 2009

View full text Add to dashboard Cite

show abstract

“…Very short stays on hospice may make it difficult for hospice care to impact quality of life of the patient and reduce the opportunity for cost savings by Medicare by avoided hospitalizations. 21,22 Policies that discourage longer lengths of hospice stay may inadvertently increase the percentage of very late referrals, which could reduce the cost benefit ratio of hospice care. If changing rules and incentives lead to reduced access to hospice care for nursing home patients, there is little existing infrastructure to provide palliative or end-of-life care to this frail population.…”

Section: Discussionmentioning

confidence: 99%

Hospice Use Among Nursing Home and Non-Nursing Home Patients

et al. 2014

View full text Add to dashboard Cite

BACKGROUND:For nursing home patients, hospice use and associated costs have grown dramatically. A better understanding of hospice in all care settings, especially how patients move across settings, is needed to inform debates about appropriateness of use and potential policy reform. OBJECTIVE: Our aim was to describe characteristics and utilization of hospice among nursing home and nonnursing home patients. DESIGN AND PARTICIPANTS: Medicare, Medicaid and Minimum Data Set data, 1999-2008, were merged for 3,771 hospice patients aged 65 years and above from a safety net health system. Patients were classified into four groups who received hospice: 1) only in nursing homes; 2) outside of nursing homes; 3) crossover patients utilizing hospice in both settings; and 4) "near-transition" patients who received hospice within 30 days of a nursing home stay. MAIN MEASURES: Differences in demographics, hospice diagnoses and length of stay, utilization and costs are presented with descriptive statistics. KEY RESULTS: Nursing home hospice patients were older, and more likely to be women and to have dementia (p<0.0001). Nearly one-third (32.3 %) of crossover patients had hospice stays > 6 months, compared with the other groups (16 % of nursing home hospice only, 10.7 % of nonnursing home hospice and 7.6 % of those with near transitions) (p<0.0001). Overall, 27.7 % of patients had a hospice stay <1 week, but there were marked differences between groups-48 % of near-transition patients vs. 7.4 % of crossover patients had these short hospice stays (p<0.0001). Crossover and near-transition hospice patients had higher costs to Medicare compared to other groups (p<0.05). CONCLUSIONS: Dichotomizing hospice users only into nursing home vs. non-nursing home patients is difficult, due to transitions across settings. Hospice patients with transitions accrue higher costs. The impact of changes to the hospice benefit on patients who live or move through nursing homes near the end of life should be carefully considered.

show abstract

“…16,17 The hospice care providers include hospice nurses, doctors, social workers, physical, speech, occupational, or dietary therapists, home health aides, spiritual counselors, and volunteers as well as someone who is available as the primary caregiver at home. This person may be a spouse, partner, or other relative, such as a son or daughter, or even a neighbor or a team of people from the community.…”

Section: Professional Carementioning

confidence: 99%

Transforming End-of-Life Care

Chung¹,

Oh²

2016

Palliat Med Hosp Care Open J

View full text Add to dashboard Cite

CitationChung BY, Oh EH. Currently, hospice care which focuses on caring for a terminally ill person delivers holistic, supportive, interdisciplinary, and patient-centered management. There have been numerous efforts to establish hospice care for people who are in the end-stage of their illness.Palliative care is an approach that improves the quality of life of patients and their families facing the problem associated with life-threatening illness, through the prevention and relief of suffering by means of early identification and impeccable assessment and treatment of pain and other problems, physical, psychosocial and spiritual (WHO). Hospice care which is a subset of palliative care focuses on controlling pain and other symptoms of illness so patients can remain as comfortable as possible near the end of life. The meaning of hospice care throughout this study is a supportive care to people in the final phase of a terminal illness and focus on comfort and quality of life.Hospice care for people with end-stage illnesses, which can involve complex endof-life care in a wide variety of settings, including bio-psycho-social symptom management, care related to cultural and ethical issues, bereavement care, and after-death care. Hospice care affects the end of life experience tremendously.1 However, let us consider hospice care at this time. Does hospice care really deliver the right care for people in the endstage of their lives? What level of hospice care do most hospice patients receive? How many people can be supported with hospice care by the government for a dignified death? For how long is hospice care required for an appropriate or good death? How much respect is there for the human rights of people in hospice care?Human dignity and human rights in end-of-life care are very important in terms of a person's identity and values, and they are accorded to and respected in everyone using hospice care services. [2][3][4][5] It is the responsibility of every hospice professional to know how to provide high quality care to people with end-stage illnesses in view of their human dignity. [5][6][7] This paper provides an overview of transforming end-of-life care. It describes not only the highest quality care for people who have had a life-limiting illness but also the trends of preparation for death, respect for the free will of people, receiving professional hospice care, and quality care after death.The goal of this paper is to contribute to the development of future hospice care from the perspective of the dignity of people. Much needs to be improved in areas such as hospice philosophy and practical support for transforming end-of-life care. HIGHEST QUALITY CAREThe highest quality care in Hospice refers to the quality, compassionate care of people facing life-limiting illnesses. Compassionate care is also holistic care. People facing life-limiting illnesses need compassionate access to a more systematic way to meet their holistic needs. Compassionate care becomes a strong and powerful interaction that encourages the...

show abstract

What length of hospice use maximizes reduction in medical expenditures near death in the US Medicare program?

Cited by 183 publications

References 21 publications

Palliative Care in the Treatment of Advanced Heart Failure

Palliative Care in the Treatment of Advanced Heart Failure

Hospice Use Among Nursing Home and Non-Nursing Home Patients

Transforming End-of-Life Care

Contact Info

Product

Resources

About