Characterizing Hospice Discharge Patterns in a Nationally Representative Sample of the Elderly,1993-2000

Abstract

The aim of this study is to identify the prevalence and correlates of individuals discharged alive from hospice in the Medicare program to determine whether the current hospice benefit matches the needs of dying patients. Using a nationally representative sample of age-eligible Medicare beneficiaries who died from 1993 to 2000, the use of hospice and other Medicare-financed care was analyzed during the last year of life for different groups of hospice users. It was found that 84.5% (n = 1029) of hospice users initiate and use it continuously until death; 15.5% of hospice users are discharged alive, with some later reinitiating hospice. The main difference between continuous hospice users and those discharged alive is the time survived after initial hospice use (those discharged alive live longer). After controlling for survival time, costs per day survived are similar for all groups. This study suggests several motivations for being discharged alive that are worthy of more research.

Keywords

hospice Medicare discharge

Get full access to this article

View all access options for this article.

References

Corr CA , Corr DM Hospice Care—Principles and Practice. New York, NY : Springer Publishing Company; 1983 .

Mor V. , Hiris J. Determinants of site of death among hospice cancer patients. J Health Soc Behav. 1983;24:375-385.

Miller GW , Williams JR Jr , English DJ , Keyserling J. Delivering Quality Care at the End of Life: Building on the 20-Year Success of the Medicare Hospice Benefit. Washington, DC : National Hospice and Palliative Care Organization; 2002 .

Morrison RS , Meier DE Palliative care. N Engl J Med. 2004 ;350:2582-2590.

Kane RL , Bernstein L. , Wales J. , Leibowitz A. , Kaplan S. A randomized controlled trial of hospice care. Lancet . 1984;1:890-894.

Greer DS , Mor V. , Morris JN , Sherwood S. , Kidder D. , Birnbaum H. An alternative in terminal care: results of the national hospice study . J Chron Dis. 1986;39:9-26.

Allston KA , Burger C. , Smith RA , Baugher RJ Comparing the quality of death for hospice and non-hospice cancer patients . Med Care. 1988;26:177-182.

Christakis NA , Iwashyna TJ The health impact of health care on families: a matched cohort study of hospice use by decedents and mortality outcomes in surviving, widowed spouses. Soc Sci Med. 2003;57: 465-475.

National Hospice and Palliative Care Organization. NHPCO Facts and Figures. Washington, DC; 2003.

10.

Casarett DJ , Marenberg ME , Karlawish JHT. Predictors of Withdrawal from Hospice. J Palliat Med. 2001 ; 4:491-497.

11.

Kutner JS , Blake M. , Meyer SA Predictors of Live Hospice Discharge: data from the National Home and Hospice Care Survey (NHHCS). Am J Hosp Palliat Med. 2002;19:331-337.

12.

Haupt BJ Characteristics of hospice care discharges and their length of service: United States, 2000. Vital Health Stat. 2003 ;13:1-36.

13.

Greer DS , Mor V. An overview of national hospice study findings. J Chron Dis . 1986;39:5-7.

14.

Kutner JS , Meyer SA , Beaty BL , Kassner CT , Nowels DE , Beehler C. Outcomes and characteristics of patients discharged alive from hospice . J Am Geriatr Soc. 2004; 52:1337-1342.

15.

Christakis NH , Escarce JJ Survival of Medicare patients after enrollment in hospice programs. N Eng J Med. 1996;335:172-178.

16.

Center for Demographic Studies, Duke University. National Long Term Care Survey. Available at: http://nltcs.cds.duke.edu. Accessed on March 16, 2005.

17.

DxCG Risk Adjustment Software, Analytic Guide Release 6.0. Boston, MA : DxCG, Inc; 2001.

18.

StataCorp. Stata Statistical Software. Release 8.0. College Station, TX: Stata Corp; 2003.