Abstract
Background
Patients with dementia form an increasing proportion of those entering hospice care.
Little is known about the types of hospices serving patients with dementia and the
patterns of hospice use, including timing of hospice disenrollment between patients
with and without dementia.
Objectives
To characterize the hospices that serve patients with dementia, to compare patterns
of hospice disenrollment for patients with dementia and without dementia, and to evaluate
patient-level and hospice-level characteristics associated with hospice disenrollment.
Methods
We used data from a longitudinal cohort study (2008–2011) of Medicare beneficiaries
(n = 149,814) newly enrolled in a national random sample of hospices (n = 577) from
the National Hospice Survey and followed until death (84% response rate).
Results
A total of 7328 patients (4.9%) had a primary diagnosis of dementia. Hospices caring
for patients with dementia were more likely to be for-profit, larger sized, provide
care for more than 5 years, and serve a large (>30%) percentage of nursing home patients.
Patients with dementia were less likely to disenroll from hospice in conjunction with
an acute hospitalization or emergency department visit and more likely to disenroll
from hospice after long enrollment periods (more than 165 days) as compared with patients
without dementia. No significant difference was found between patients with and without
dementia for disenrollment after shorter enrollment periods (less than 165 days).
In the multivariable analyses, patients were more likely to be disenrolled after 165 days
if they were served by smaller hospices and hospices that served a small percentage
of nursing home patients.
Conclusion
Patients with dementia are significantly more likely to be disenrolled from hospice
following a long enrollment period compared with patients without dementia. As the
number of individuals with dementia choosing hospice care continues to grow, it is
critical to address potential barriers to the provision of quality palliative care
for this population near the end of life.
Keywords
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Article info
Publication history
Published online: November 16, 2017
Footnotes
The authors declare no conflicts of interest.
Identification
Copyright
© 2017 AMDA - The Society for Post-Acute and Long-Term Care Medicine.
