Abstract
Involvement in a hospice program is important because it may allow individuals with dementia to delay or prevent institutionalization as well as provide psychosocial support for their families. Once used mostly by patients with a terminal cancer, now more than one half of the hospice patients have diagnoses other than cancer. Yet hospice is still underused for individuals dying with advanced dementia. We conducted a pilot study of hospice agencies to determine barriers and characteristics of dementia hospice enrollment. Using a mailed questionnaire and interview, we looked at demographics, accessibility, training, referral sources, and marketing. Our analysis divided the agencies based on dementia census and availability to non-Medicare eligible individuals. Results showed hospices having Bridge and Transition programs had on average 4 times higher Alzheimer’s disease (AD) and dementia census than hospices without these programs. The highest rated barriers to hospice use for individuals with dementia were prognosis, education, and finance.
Keywords: bridge program, transition program, hospice, dementia, enrollment
Full Text
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Contributor Information
Catherine Elizabeth McCarty, School of Aging Studies, University of South Florida, Tampa, Florida, cmccarty@cas.usf.edu .
Ladislav Volicer, School of Aging Studies, University of South Florida, Tampa, Florida.
References
- Mitchell SL, Morris JN, Park PS, Fries BE Terminal care for persons with advanced dementia in the nursing home and home care settings. J Palliat Med. 2004; 7(6):808-816. [DOI] [PubMed] [Google Scholar]
- Nursing Home End-of-Life Care: The Nursing Home/ Hospice Partnership. www.chcr.brown.edu/NHHSP/execsum.html. Accessed May 22, 2008. [Google Scholar]
- Burton LC, German PS, Gruber-Baldini AL, Hebel JR, Zimmerman S., Magaziner J. Medical care for nursing home residents: differences by dementia status. J Am Geriatr Soc. 2001;49(2):142-147. [DOI] [PubMed] [Google Scholar]
- Dobbs D., Hanson L., Zimmerman S., Williams CS, Munn J. Hospice attitudes among assisted living and nursing home administrators and the long-term care hospice attitudes scale. J Palliat Med . 2006;9(6):1388-1400. [DOI] [PubMed] [Google Scholar]
- Travis SS, Bernard M., Dixon S., McAuley WJ, Loving G., McClanahan L. Obstacles to palliation and end-of-life care in a long-term care facility . Gerontologist. 2002; 42(3):342-349. [DOI] [PubMed] [Google Scholar]
- Keay TJ, Schonwetter RS The care for hospice care in long-term care environments. Clin Geriatr Med. 2000; 16(2):211-223. [DOI] [PubMed] [Google Scholar]
- Luchins DJ, Hanrahan P., Murphy K. Criteria for enrol-ling dementia patients in hospice. J Am Geriatr Soc. 1997;45(9):1147-1149. [DOI] [PubMed] [Google Scholar]
- Schonwetter RS, Han B., Small BJ, Martin B., Tope K., Haley WE Predictors of six-month survival among patients with dementia: an evaluation of hospice medicare guidelines. Am J Hosp Palliat Care. 2003; 20(2):105-113. [DOI] [PubMed] [Google Scholar]
- Thompson GN, Chochinov HM Methodological challenges in measuring quality care at the end of life in the long-term care environment. J Pain Symptom Manage. 2006;32(4):378-391. [DOI] [PubMed] [Google Scholar]
- Appollonio I., Gori C., Riva G., et al. Assessing early to late stage dementia: the TSI and BANS-S scales in the nursing home. Int J Geriatr Psychiatry. 2005;20(12): 1138-1145. [DOI] [PubMed] [Google Scholar]
- Lunney JR, Lynn J., Foley DJ, Lipson S., Guralnik JM Patterns of functional decline at the end of life. JAMA. 2003;289(18):2387-2392. [DOI] [PubMed] [Google Scholar]
- Miller SC, Mor VN The role of hospice care in the nursing home setting. J Palliat Med. 2002;5(2):271-277. [DOI] [PMC free article] [PubMed] [Google Scholar]
- National Hospice and Palliative Care Organization. NHPCO Facts and Figures: Hospice Care in America. http://www.nhpco.org/files/public/Statistics_Research/NHPCO_facts-and-figures_Nov2007.pdf . Accessed August 18, 2008. [Google Scholar]
- Munn JC, Hanson LC, Zimmerman S., Sloane PD, Mitchell CM Is hospice associated with improved end-of-life care in nursing homes and assisted living facilities? J Am Geriatr Soc. 2006;54(3):490-495. [DOI] [PubMed] [Google Scholar]
- Plassman BL , Langa KM, Fisher GG, et al. Prevalence of cognitive impairment without dementia in the United States. Ann Intern Med. 2008;148(6):427-434. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Reisberg B. Functional assessment staging (FAST). Psychol Bull. 1988;24(4):653-659. [PubMed] [Google Scholar]
- Harrold J., Rickerson E., Caroll JT, et al. Is the Palliative Performance Scale a useful predictor of mortality in a heterogeneous hospice population? J Palliat Med. 2005;8(3):503-509. [DOI] [PubMed] [Google Scholar]
- Mor V., Laliberte L., Morriss JN, Wiemann M. The Karnofsky Performance Status Scale. An examination of its reliability and validity in a research setting. Cancer. 1984;53(9):2002-2007. [DOI] [PubMed] [Google Scholar]
- Mitchell SL, Kiely DK, Hamel MB, Park PS, Morris JN, Fries BE Estimating prognosis for nursing home residents with advanced dementia. JAMA. 2004;291(22):2734-2740. [DOI] [PubMed] [Google Scholar]
- Braveman C. Bridge Programs: Definitions, Criteria, Reimbursement and Process. MA: Hospice and Palliative Care Federation; 2008. http://hospicefed.org/download/bridge_report.pdf . Accessed May 19, 2009. [Google Scholar]
- Transitions PreHospice. Transitions, advancing end of life care. www.prehospice.com. Accessed August 18, 2008. [Google Scholar]
- McCarty TD OIG Advisory Opinion No. 00-3; 2000. oig.hhs.gov/fraud/docs/advisoryopinions/2000/ao00_3.htm . Accessed August 18, 2008. [Google Scholar]