The availability of hospice care at nursing homes reduces costly and invasive hospital stays for residents and generally improves their quality of life during their final days.
That is the finding of a study by Brown University researchers, which appeared in the American Journal of Medicine earlier this month.
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The study found that 44 percent of nursing-home residents who went without hospice care ended up in the hospital during the month before their death, while only 24 percent of hospice residents were hospitalized. For residents enrolled in hospice for the entire 30 days leading up to their deaths — rather than just a portion of that time — only 1 percent required hospitalization.
“We feel that having hospice care in nursing homes improves (the homes’) ability to maintain residents in place,” said Susan Miller, assistant professor in the Center for Gerontology and Health Care Research at Brown and the study’s lead author.
Keeping residents in their nursing homes during their last days of life generally improves comfort and avoids the often-invasive acute-care interventions that come with hospitalization, the study found. Also, it saves Medicare money, because that program pays for end-of-life hospitalizations.
The study compared 9,202 nursing home residents in five states (Maine, New York, Kansas, Mississippi and South Dakota) who enrolled in hospice between 1992 and 1996 and died prior to 1998 vs. 27,500 non-hospice residents.
Miller highlighted another finding of the study: Even nursing-home residents who aren’t enrolled in hospice, but live in homes that offer hospice services, are less likely to be hospitalized than patients in homes where hospice is unavailable.
“It seems the philosophies and practices of hospice are adopted by the nursing-home staff, so its presence influences the care of all the patients,” Miller said.
Hospice care emphasizes maintaining quality of life for dying patients rather than curative treatment. Caregivers work to provide comfort for dying patients through pain management, while promoting the involvement and support of family.
Nursing homes gradually have contracted to offer hospice services since the mid-1980s, when the federal government declared nursing homes eligible for hospice-related Medicare reimbursement. Roughly half of U.S. nursing homes offer hospice care contracted through Medicare, according to the Brown study.
About 25 percent of deaths of elderly people in the United States occur in nursing homes.
Miller recommends that prospective nursing-home residents and their families consider the availability of hospice care when choosing a nursing home. She estimated that roughly 30 to 40 percent of families ask about hospice availability when evaluating a home.
“A lot of people don’t even know hospice care is available,” said Diane Madsen nursing-home liaison for Hospice Care of Rhode Island, the state’s largest hospice provider. “It’s a service that is extremely underutilized.”
Hospice Care of Rhode Island contracts to provide hospice services to about 60 nursing homes in the state, Madsen said. Although the number of nursing-home patients served by the organization has grown over the past year, she said there should be many more referrals.
“The referrals come far too late,” Madsen said. “We’re a death-denying society and nobody wants to talk about it.”
