Share on Pinterest Many families are unaware that hospice is an option available for end-of-life dementia care. Advertising by Catherine Falls / Getty Images
- A new study looked at the medical records of people over the age of 70 with dementia who received hospital care.
- The study showed that most patients performed better in terms of quality of care and mental health, and were less likely to be transferred to another center.
- According to experts interviewed for this story, hospital care is an underused option for people with dementia and can offer support and care for up to six months.
Families of people with dementia are sometimes reluctant to use hospital care. You may feel that you are giving up on your loved one. But inpatient care often provides excellent care and relieves anxiety and sadness compared to patients with dementia who do not receive inpatient care, according to a new study published in Health Affairs.
Researchers at the University of California at San Francisco and Mount Sinai Icahn School of Medicine in New York City analyzed the medical records of 2,059 people over the age of 70 who died between 2011 and 2017. Of these, 40 percent were diagnosed with dementia and 59 percent used hospital care.
“The overall goal of hospital care is to provide measures of dignity, support and comfort to end-of-life patients and their families,” says Gail Trauco, RN, BSN-OCN. It includes regular visits by nursing staff, social workers, and clergy, and is offered at the patient’s residence, assisted living or nursing home, a dedicated area of a hospital, or independent hospice.
Very often, the children or spouses, representing the patients, provided information about the end-of-life care that their loved ones received. The finding included:
- 52 percent described care as excellent compared to 41 percent of outpatients
- 67 percent indicated that sadness and anxiety were managed, compared with 46 percent of non-hospice patients.
- Those admitted to the hospice were less likely to move to a different care setting in the days before their death.
Krista L Harrison, Ph.D., an adjunct professor in the UCSF’s Geriatrics Division, was surprised by the findings: “We sincerely hope it wasn’t positive. Because the hospice model was designed for patients. with cancer, we expected end-of-life care to be worse for people with dementia. “
Hospice services are underused, says Dr. Scott Kaiser, director of Geriatric Cognitive Health at the Pacific Institute of Neuroscience. “While people may qualify for the last six months of their lives, hospice services often only start in the last few weeks or days.”
Families considering hospice care can begin the process by contacting the patient’s family primary care physician, who can initiate referrals. Families can also contact hospice organizations directly and start the conversation. According to Trauco, the signs that it may be time to consider the hospice include:
According to Kaiser, hospice services can help decrease hospitalizations, control pain, and control other symptoms. “It can fill many common gaps in care, providing a full range of services focused on providing comfort and support. This includes services tailored to the needs of families and other caregivers. Hospice benefits can also be extended to support mourning for surviving relatives after the death of a patient “.
Specialists perform an assessment of the patient and family before the hospice begins to determine the needs of the patient and family. The hospice provider uses this information to tailor the program to your unique needs.
Medicare pays for hospital care, but “eligibility criteria could mean that some patients with dementia face barriers to accessing the hospice or may risk being discharged,” the researchers found. There must be documentation of continuous decline for patients to remain eligible. One study found that many people drop out of the hospice because they no longer meet the six-month death forecast. Although they still have dementia, and this will not resolve on its own, their physical condition has stabilized. This causes the family and caregivers to struggle to care for their loved ones.
“To be eligible under Medicare, there are some minor hurdles that need to be removed before the hospice begins. First, your regular doctor and hospice must certify that you are terminally ill. Second, you must accept treatment. palliative care for your condition instead of medical care aimed at treating your condition.Finally, you must sign a document that selects hospital care instead of other Medicare-covered care for your condition, “says Robert Rees, Medicare’s vice president of sales for eHealth.
The hospice organization can help you meet your financial and insurance obligations. “All hospice organizations should have financial support staff,” Trauco says. “Many are free because of donations and grants if the insurance doesn’t cover it.”
Most people who receive hospital care stop receiving curative medical care for conditions unrelated to their terminal illness. They receive attention to keep them comfortable.
Harrison said the hospice significantly benefits those with dementia and stresses the need to ensure access to high-quality end-of-life care for this growing population. “Future work should examine whether removing the prognostic requirements for hospice eligibility for people with dementia positively affects timely access and quality of care.”