Factors contributing to late hospice admission and proposals for change

Abstract

Introduction: Hospice seeks to provide high-quality, holistic end-of-life care. Most insurances will reimburse hospice care for a period of six to seven months. However, the majority of patients are not referred to hospice until they are very close to death. The purpose of this study was to examine characteristics of an urban hospice program that may be associated with inordinately late admission to hospice care.

Methods: A retrospective chart review of 100 consecutive admissions was carried out. Patient data from the referral/intake forms were reviewed and length of stay of each patient was calculated.

Results: The average length of stay in this hospice was 34 days. Over half of the patients (51 percent) died within 14 days, and more than one-third (35 percent) died within seven days of admission. African-Americans made up nearly one-third of the patient group (32 percent). A considerable number of patients had a non-cancer diagnosis (39 percent). More than half of the patients were referred from acute care hospitals/specialists (58 percent).

Conclusion: The study shows that most patients were referred to this urban hospice program when they were very close to death. Three characteristics may contribute to this underutilization of the hospice benefit: (1) the large representation of African-Americans, (2) the high enrollment of patients with non-cancer diseases, and (3) the high number of referrals from acute care hospitals/specialists. Initiatives to overcome barriers to hospice care for minority populations, to better prognosticate terminal illnesses, and to educate physicians and patients about palliative care are needed so that more patients can benefit more fully from hospice care at the end of life.