Literature Review

Study uncovers racial inequalities in hospice utilization, length of stayMcKnight’s Home Care DailyDecember 12, 2023Blacks and Hispanics are less likely to use hospice services, and those who do often have shorter lengths of stay than white patients, according to a new study published in JAMA Health Forum. ... Minority patients also generally experienced shorter hospice lengths of stay. Hispanic patients in particular were more than twice as likely to stay in hospice care for seven days or less, compared to the average white Medicaid beneficiary. Still, short length of stay was relatively common across the board at about 40%, which suggests “room for improvement in referring all Medicaid recipients to hospice earlier in the course of terminal illness,” the study’s authors wrote. As to possible reasons for these disparities, the researchers noted that language barriers, mistrust of hospice programs or cultural differences might be at play. But also, the inequity might also reflect “potential racial biases that affect who a physician is more likely to refer to hospice,” according to the study. Specific, targeted efforts to encourage hospice services for Medicaid and dual-eligible beneficiaries who show low rates of utilization may help to overcome these disparities.

‘Hospice is more about living better’ transitional care director says of misunderstood programTribune-Review (Pittsburgh, PA)December 11, 2023... There is an assumption a patient entering hospice care is not expected to live beyond six months, a guideline that is tied to Medicare coverage. But the experience of individual patients can vary widely, as evidenced by [senior living residents] the Pattersons [Robert, 97, and Joyce, 90,] and by former president Jimmy Carter and his late wife, Rosalynn. Like many who elect to receive hospice care, Rosalynn Carter entered the program toward the very end of her life—just days before her death Nov. 19, at 96. But it’s also possible for patients to beat the odds and have hospice care extended. Jimmy Carter was 98 when he entered hospice in February and continues to endure. 

Shifting focus to MA will alter ‘life as we know it’ for home care providers, experts sayMcKnight’s Home Care DailyDecember 7, 2023Medicare Advantage is disrupting the traditional home care landscape, experts from the Research Institute for Home Care said in a webinar hosted Wednesday afternoon by the National Association for Home Care & Hospice. As MA continues to dominate Medicare and cover those beneficiaries receiving home health, certain trends—such as access issues or shifting utilization rates for services within traditional Medicare—have become more pronounced. “Medicare Advantage is growing, and that’s going to result in a decreased volume in home health claims among traditional Medicare beneficiaries,” Elizabeth Hamlett, senior research associate for evaluation and health economics at KNG Health, said during the webinar about the recently released 2023 RIHC [Research Industry for Home Care] Chartbook. Home health users in general also may become more reflective of the characteristics of MA beneficiaries—which essentially means sicker and poorer, she said. ... However, MA and fee-for-service beneficiaries showed greater variation in their reported access to home health services. “What we’re seeing here is potentially an access problem for Medicare Advantage users,” Hamlett said.