Journal Reviews.eps

Nursing home residents with dementia use hospice

Increased use improves patient care

A study of nursing home records shows more residents with dementia are seeking hospice care and use the benefit for a longer period of time.1 The study, published in American Journal of Alzheimer's Disease and Other Dementias, used records of more than 3.8 million deceased nursing home residents.

The report shows that the proportion of nursing home residents who benefited from Medicare hospice care nearly tripled between 1999 and 2006 and that the duration of care more than doubled. The authors note that hospice care provides important medical benefits to patients with dementia, including more attentive assistance with feeding and medication, that can improve quality of life.

Because the prognosis of someone with dementia is hard to determine so precisely, some patients with dementia have remained in hospice care for much longer than six months, which is a concern for Medicare officials, the authors say. While the national average hospice length of stay for nursing home patients with advanced dementia increased from 46 days in 1999 to 118 days in 2006 — still within the six-month time frame — in eight states more than 25% of such patients retained hospice care for more than six months. Oklahoma had the largest proportion of long-staying patients with 46.6%, followed by Alabama, New Mexico, Wyoming, South Carolina, Mississippi, Arizona, and North Dakota.

The variations revealed in the state-by-state data suggest that very long stays are not just a product of a general uncertainty about prognosis but also a reflection of different practices such as physicians supporting early admission to hospice, in different parts of the country.

Reference

1. Miller SC, Lima JC, Mitchell SL. Hospice care for persons with dementia: The growth of access in U.S. nursing homes. Am J Alzheimers Dis Other Demen 2010;25:666-673.