More people are dying in hospice care rather than a hospital, though the shift hasn't led to less aggressive treatment or lower costs.
Hospice care has doubled in the past decade, now accounting for about 40 percent of Medicare beneficiaries' deaths, says a report in the Journal of the American Medical Association. For many, the transition to hospice came in the final days of life, often after multiple hospital stays and time in intensive care units.
Hospice treats the pain and discomfort of dying patients whose underlying disease can't be cured. The programs often enable patients to die at home and are far less costly than hospital care.
Dr. Joan Teno, one of the authors, said she is troubled that terminally ill patients aren't admitted sooner to hospice, where they can benefit from supportive care, instead of first going through lengthy intensive care and hospital stays. “Hospice is now just an add-on to an aggressive pattern of care where they go from hospitalization, to the ICU to hospice in the last days of life,” said Teno, a professor at Brown University. “This isn't going to change our health care spending or improve quality of care at the end of life.”
In 2009, 42 percent of the deaths occurred in hospice care, up from 22 percent in 2000, the study found. About 59 percent of cancer patients and 48 percent of dementia patients were enrolled in hospice at death, researchers said. Deaths in hospitals fell to 25 percent in 2009, from 33 percent in 2000.