Hospice Care - Not Just for the Dying

Understanding Hospice Key to Wider Use and Acceptance

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Hospice care is often misunderstood. Sure death is a scary topic but hospice is so much than about dying though it can help a loved one die with dignity and grace. Understanding some of the trends in hospice can further help to alleviate fear and promote understanding. In fact, it has been documented that earlier enrollment in hospice improves end of life care. The National Hospice and Palliative Care Organization is a go-to source for understanding the hospice marketplace.

Here is a quick look at some statistics.

Stats
 

  • In 2014, an estimated 1.6 million patients received services from hospice.
  • Four of ten deaths in the United States are under the care of a hospice program.
  • Medicare patients accessing three or more days of hospice services grew to 43.3%.
  • Those with dementia accessing services grew to 33.6%.
  • The median length of service iis 19.7 days.
  • The majority of patient care, 58.9% is received at home, which include includes nursing homes and residential facilities.
  • The percentage of hospice patients receiving care in a hospice inpatient facility is 31.8%.
     

Primary Diagnosis

When hospice care in the United States was established in the 1970s, cancer patients made up the largest percentage of hospice admissions. Today, cancer diagnoses account for less than half of all hospice admissions. Currently, less than 25 percent of U.S. deaths are now caused by cancer, with the majority of deaths due to other terminal diseases.

The top four non-cancer primary diagnoses for patients admitted to hospice are heart disease (14.3%), debility unspecified (13.0%), dementia (13.0%), and lung disease (8.3%). This is important to know as you seek to expand your reimbursement sources and also look to expand the skill sets of the hospice care team.

The Medicaid hospice payment rates are calculated based on the annual hospice rates established under Medicare. The Medicaid hospice daily payment rates for care and services provided from October 1, 2011, through September 30, 2012, are as follows:

  • Routine Home Care - $161.89
  • Continuous Home Care - $944.79
  • Inpatient Respite Care - $167.45
  • General Inpatient Care - $720.11
     

Services Provided

According to National Health Statistics, the core services provided by the hospice care team include:

  • Medical Social Services
  • Pastoral or Spiritual Services
  • Physician Services
  • Dietry Services
  • Volunteer Services

Discharged hospice care patients in agencies that were part of a chain were more likely to receive physician services than discharged hospice care patients in agencies that were not part of a chain.

Among non-core services:

  • Received Assistance with ADLs
  • Homemaker Services
  • Continuous Home Care
  • Respite Services
  • Therapeutic Services

Use of Advanced Directives or Some Type of Advanced Care Planning

The vast majority of discharged hospice care patients had advance care planning from 75.8% of those under age 45 to 93.1% of those aged 85 and over.

Over one-fourth (26.9%) of all discharged hospice care patients had three or more types of advance care planning instruments. The most common type of advance care planning instrument among discharged hospice care patients was a do-not-resuscitate order (80.2%), followed by a durable power of attorney (36.4%) and a living will (25.3%).

For consumers, it is important to have an advanced directive (living will) in place to spell out your health care wishes and it is equally important to appoint a healthcare power of attorney who can follow your wishes should you not be in a position to communicate them.

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