Hospice Rates Rise, But Hospitalizations Remain High

Cheryl Clark, February 16, 2011

Use of hospice for Medicare patients with congestive heart failure has been on a dramatic upswing, one important example of how the U.S. healthcare system is changing the way it treats terminal patients in their last six months.

Not only did the percentage of patients who used hospice go up, from 19% in the year 2000 to 40% in 2007, total number of days in hospice care increased from 36.5 days to 44 days and the percentage discharged to a hospice from an inpatient setting went from 5.2% to 33.7%.

Those are some findings from an analysis of care provided to 229,543 Medicare beneficiaries with CHF who died between Jan. 1, 2000 and Dec. 31, 2007 by researchers at Duke University and the Universities of Alberta and Calgary in Canada. Their paper is published in this week's print edition of the Archives of Internal Medicine.

"We found that most patients frequently accessed the healthcare system and spent some time in the hospital," they wrote. "The use of health services at the end of life in this population has increased over time, with higher rates of intensive care and higher costs. However, the use of hospice services has also increased markedly, representing a substantial shift in patterns of care at the end of life."

But "there continues to be a high level of use of inpatient care in the last six months of life," the researchers said, "with approximately 80% of patients spending some time in the hospital."

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