Nobody likes thinking about the end of life, but it is a universal human experience. The subject of death, even in health care settings, can be difficult to broach. There continue to be misconceptions about hospice and what it means to elect this type of care. The prevalence of hard-to-predict diagnoses like Alzheimer’s and dementia pose additional challenges when considering hospice, and patients, families and providers often grapple with some uncertainty. Ultimately, calculating hospice’s value is complex and must consider a patient’s quality of life and satisfaction relative to their prognosis.
Hospice helps people with limited life expectancy achieve peace and comfort through whole-person care while reducing the stress and pain of a serious illness or injury. There are a lot of incorrect interpretations that equate hospice with choosing death, recently exemplified by the outpouring of tributes following President Carter’s decision to enter hospice care. (Nearly six months later, he is still enjoying time with his family and loved ones at home.) Contrary to popular belief, hospice does not hasten death – it supports the natural progression of life while focusing on comfort care and making the patient’s quality of life as positive as possible in their final months, weeks and days.
Despite numerous studies touting the benefits of hospice in the final days and weeks of life, the median length of stay has remained stagnant at 18 days for more than a decade. Moreover, 25% of hospice patients die in 5 days or less. This suggests that despite research, patients and families struggle to proactively consider hospice care before the last days of life.Why is this? Accepting the end of life is extremely difficult, and that stress can be compounded considering only one-third of U.S. adults have documented their wishes for end of life care. This passes the responsibility to family members in the event their loved one can’t speak for themselves. With advanced care planning and improved communication between patients, families and providers regarding goals of care, this situation is preventable.
In addition to the increased benefits patients and loved ones enjoy by enrolling in hospice earlier, stays beyond six months also save the Medicare program money. An analysis of Medicare claims data for 2.3 million beneficiaries who died in 2019 showed an estimated savings of $3.5 billion for those who used hospice. A 2023 report by the National Bureau of Economic Research further validated the impact of longer hospice stays on Medicare savings, finding spending was 11% lower for Alzheimer’s and dementia beneficiaries who spent at least six months in hospice.
Health care organizations can bridge gaps in understanding end of life choices by partnering with hospice care providers to support their clinicians with patient identification, goals of care conversations and care delivery. Most people overwhelmingly prefer to receive care at home and hospice providers can partner with hospitals and health systems to manage referrals and provide care, working as an extension of acute care teams.
Technology also allows for greater insight into patient prognoses and interoperability among hospices and health systems. Tools like remote patient monitoring and predictive analytics can support clinicians in identifying progressing symptoms and indicate additional support needed for the last days of life for hospice patients. Hospice care teams can use data to provide real-time updates to referring physicians and offer insight into disease trajectories – an especially useful tool as Alzheimer’s and dementia patients now make up the majority of hospice diagnoses and account for roughly half of all hospice stays lasting more than six months. These technological innovations allow for enhanced communication and information flow to support clinical decision-making aligned with patient goals of care.
Hospice looks different today than it did in 1982 when it was first introduced as a Medicare benefit. Patients electing hospice have more diverse diagnoses, many of which are made more tolerable through comfort-focused care. Yet a continued lack of understanding about the benefits and advantages for patients and providers threaten its ability to impact the lives of many who could use this care. Policies limiting patient eligibility and reimbursements for hospice providers threaten access or continuation of service at the most vulnerable stage.
Despite these challenges, hospice continues to be one of the most innovative and effective care delivery models in Medicare, bringing comfort, peace and support to patients and families when they are at their most vulnerable.
As national health expenditures continue to grow and more people become Medicare eligible, it is critical we support solutions that align with patient and family preferences, increase satisfaction and reduce unnecessary financial burden. We may not be able to universally calculate the full value of hospice, but we can’t afford the cost of failing to improve understanding, utilization and timely access to this type of care for our population and health care system.
David Grams
David Grams is CEO of Compassus, a leading national provider of integrated home-based care services including home health, infusion therapy, palliative and hospice care.
