Hospice patients get too little care in last days of life, study says

The U.S. Centers for Medicare and Medicaid Services changed its policies for hospice care payments for 2016 in order to encourage more visits toward the end of life.

By Stephen Feller

WASHINGTON, Feb. 9 (UPI) -- One in eight hospice patients do not see a doctor, nurse, or social worker during their last two days of life, researchers for the federal agency responsible for the end-of-life programs found in a recent study.

The U.S. Centers for Medicare and Medicaid Services changed its policies for hospice care payments for 2016 in order to encourage more visits toward the end of life, when the agency says families are most overwhelmed and patients often experience significant changes in symptoms and pain.


The change, effective Jan. 1, adds a "service intensity add-on payment" for up to four hours per day during the last seven days of life for a registered nurse or social worker, will address some of the problem, researchers said. Previously, Medicare paid a single rate per patient, regardless of how many times a medical professional visited them.


Hospice is a specialized type of care meant for the physical and emotional needs of people dying from incurable disease, and to help their families care for them and cope.

Aside from rural locations affecting the availability of some services, the researchers at the University of Washington who conducted the study also noted a lower likelihood of visits for patients who are black, die on a Sunday, or are in a nursing home.

"They can make changes to ensure that the dying patient is comfortable and to provide education to the family on how to care for the patient in the last days of life," Dr. Joan Teno, a professor of medicine at the University of Washington, told HealthDay of the importance for medical professionals to see patients in their last days of life.

For the study, published in JAMA Internal Medicine, researchers analyzed medical records for the last two days of life of 661,557 Medicare beneficiaries who died in hospice between October 2013 and September 2014.

The researchers found 12.3 percent of all patients in the study received no professional staff visits in their last two days of life, with rates ranging from 3.8 percent of patients in Wisconsin to 19.7 percent of patients in Alaska seeing no medical professionals before they died. Among 3,400 hospices, 8 percent didn't visit any patient during their last two days of life and less than 1 percent visited all patients in their final two days.


Black patients were about one-third less likely than white patients to have visits in their last two days, and people dying in a nursing home were 1.74 times less likely to have visits than people dying at home. Patients who died on a Sunday were 3.35 times less likely to be visited compared to people who died on a Tuesday, the study also found.

Although the researchers were hopeful the payment change can correct some of the problem, researchers in an editorial also published in JAMA Internal Medicine suggest more research is needed to determine exactly what families need -- which has a better chance of solving the problem, they say.

"Rather than putting too much emphasis on a process measure," they wrote, "our goal should be to directly measure what matters to patients and their family members, use these data to craft solutions to improve the delivery of care by individual hospice programs, and ensure open access to this information to promote the best possible experiences for patients and their families near the end of life."

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