Home Health Care Linked to Increased Hospice Utilization

Recent research has uncovered improved hospice utilization rates among patients who had received home health services.

Researchers from New Jersey-based Rutgers University’s School of Nursing have found that patient preferences leaned toward home-based hospice services following home health experiences.

The study, published in the Journal of Palliative Medicine, examined home health and hospice care outcomes during the last three years of life among more than 2.1 million Medicare decedents who died in 2019.

Use of home health care was “strongly associated” with a higher likelihood of hospice utilization at the end of life among all the patients, said researcher Olga Jarrín, associate professor and Hunterdon-endowed professor of nursing research in the Division of Nursing Science at Rutgers Health’s School of Nursing.

“There was a very strong relationship between using home health care in the last year, or even earlier in two or three years before death, and then going on to use hospice at the end of life,” Jarrín told Hospice News. “We found this both for people that were diagnosed with dementia, as well as people that did not have a dementia diagnosis.”

Individuals receiving home health care before the last year of life were 13% more likely to enroll in hospice than those who did not, the research found. Additionally, patients receiving home health during the final year of life were also more likely to utilize hospice.

The findings highlight the importance of referral relationship building when it comes to continuity and goal concordant care, Jarrín indicated.

“From the hospice side, it’s about relationship building,” Jarrín said. “[There are] things that we can do to improve continuity of care. There’s a lot of opportunity for someone who’s receiving home health [and] for the patient and family to be able to develop the skills, the sense of agency and the advocacy skills that support aging in place at home and choosing care that fits with their goals and desires later in life. It’s getting to know these home health agencies working in the same community serving the same population [and] making sure [there are] opportunities for referrals.”

Some reasons that hospice utilization was greater among home health patients could be increased clinical care at the bedside, according to Jarrín. People receiving home health may be more likely to have conversations around their goals of care as their illnesses progress, with greater likelihood of receiving referrals to advance care planning, hospice and palliative care as a result, she indicated.

Home health, hospice ties among dementia patients

Patients both with and without dementia-related conditions were included in the research. With dementia conditions growing more common among today’s seniors, having data around end-of-life care utilization trends is important, according to Jarrín.

Nearly half (43%) of the more than 2 million Medicare decedents included in the research were diagnosed with dementia during their lifetime. Of those with dementia, 54.8% used home health care and 63.3% utilized hospice.

“The effect of the relationship between home health care and hospice was stronger for people that were not diagnosed with dementia,” Jarrín said. “But it’s more [so] bringing up the level of the use of hospice in people without dementia similar to the level among people with dementia diagnoses. There’s much more people with dementia using hospice to begin with, so there’s slightly less room for there to be a strong effect. But it’s still strong across the board.”

Of the nearly 1.2 million Medicare decedents who utilized hospice in 2019, about 591,272 had dementia, the research found.

Issues among dementia patients and family caregivers are at the forefront of an increasing number of research initiatives such as these, said Jarrín. Health care providers nationwide are seeking ways to improve care and address challenging needs of patients along the different advanced stages of dementia, including the final years of life, she indicated.

“It’s important to be thinking about these issues early on when someone begins to develop issues with memory or cognitive impairment [than to] wait too long to have these conversations about what kind of end-of-life care they might like, or be able to have those conversations as a family before it’s the final end,” Jarrín told Hospice News. “It’s important that it’s always in the forefront of what we’re doing when disseminating the results. There’s all these other issues when someone especially goes into the more advanced stages of dementia.”