HOSPICE CARE: Use Grows, but Length of Stay Shortens
Patients are spending a shorter amount of time in hospices and may therefore not be utilizing all that the facilities have to offer, according to new University of Chicago data reported in today's Chicago Tribune. An unpublished UC study indicates that half of all patients at five large Chicago-area hospice networks die 22 days or less after they enter the facilities, and nearly 25% die in a week or less - - far short of experts' recommendation that patients spend at least three months under hospice care, according to researcher Dr. Nicholas Christakis. New York State Hospice Association President Amber Jones said, "[H]ospice is becoming brink-of-death care, instead of quality end-of-life care." The Tribune notes that the decrease in average length of stay comes at a time when hospice care is more popular than ever: 500,000 people utilized services last year -- more than double a decade before -- and the number is growing at a 10% annual clip.
Why oh Why?
Experts say reasons behind the shortened lengths of stay could include increased use of new therapies and technologies for seriously ill cancer patients; physicians, patients and families refusing to accept death; and the "chilling effect" of a federal Medicare fraud probe. As hospices move beyond their traditional focus on cancer patients, physicians struggle to predict which patients are likely to live under six months, the maximum length of time reimbursable under Medicare. Physicians fearful of fraud investigations and unsure how long patients will live are unlikely to refer them to hospices until they are very close to death. Short hospice stays hurt facilities' bottom lines; hospice administrators estimate they need patients to stay "at least 15 days" to break even. The Chicago Tribune reports that another unpublished study confirms the trend toward shortened stays: A report by the National Hospice Organization found the median patient stay fell 14% between 1995 and 1998, to 25 days. States with the shortest median stays were Tennessee (13 days) and Oregon (16 days). South Carolina (42 days) and Nebraska (36 days) topped the list (Graham, 5/12).