Hospices See Growth Opportunities with Physician Offices, Memory Care

Hospice providers are increasingly focused on memory care settings and physician offices as referral sources.

Though many hospices see facility-based care as their primary referral engines, a growing base of providers are seeking ties to community-based organizations to increase access and utilization this year.

Physician offices were identified among the most significant referral growth opportunities in 2024 by about 6% of 143 respondents to Hospice News’ 2024 Outlook Survey, conducted with Homecare Homebase. Meanwhile, 7% reported that their hospice organizations saw memory care settings as a significant referral source.

Memory care settings and physician offices represent uncharted territory in terms of exploring upstream hospice referral avenues, according to Jamie Brown, chief operating officer at Eden Health. The home health, hospice and palliative care provider operates 43 locations across eight states with an average daily census of more than 3,300 patients.

“A majority of our referrals come from inpatient settings such as hospitals and skilled nursing facilities, but there is a lot of untapped potential in physician offices and memory care providers,” Brown told Hospice News in an email. “Our experience with physician offices is that they often end up not always knowing or feeling comfortable enough with having the ‘hospice conversation’ with patients and families. From a strategic alignment point of view, it’s our job as hospice providers to partner with them so that they don’t have to do that alone.”

Forces fueling memory care, physician referrals

As the population ages, memory care settings are gaining momentum as referral sources, along with new physician relationships. An estimated 82 million Americans will be 65 and older by 2050, a 47% increase from 58 million in 2022, according to the Population Reference Bureau.

Among those, roughly 6.7 million seniors experienced Alzheimer’s or dementia-related diseases in 2023, a number projected to triple by 2060, reported the U.S. Centers for Disease Control and Prevention (CDC).

Dementia-related conditions and cancer in 2021 were the most frequently occurring principal diagnoses for Medicare decedents who elected the hospice benefit, according to the National Hospice and Palliative Care Organization (NHPCO).

Seniors with dementia represent a challenging demographic to manage as they reach the final stages of life, with unpredictable and complicated health trajectories, said Lindsay Nixon, administrator at Arbor Hospice.

A main draw for hospices seeking memory care referral partnerships is the potential to better manage symptoms at the end of life for longer periods of time, Nixon stated.

Based in Ann Arbor, Michigan, Arbor Hospice provides community-based hospice, palliative and pediatric care . The nonprofit hospice in 2016 affiliated with Hospice of Michigan, becoming founding members of the parent brand NorthStar Care Community (NSCC). Collectively, Arbor Hospice and Hospice of Michigan offer hospice, pediatric and palliative services to more than 6,100 patients annually across 50 counties in its home state. 

Like hospices, memory care and physician offices are enduring workforce headwinds, according to Kelly Errer, market director of Arbor Hospice and Hospice of Michigan.

“Some of the challenges in memory care facilities and physician offices involve staffing. A lot of them are facing shortages and turnover,” Errer said. “It’s about being a support as the hospice and palliative care organization to their staff and how we share our resources, education, expertise and knowledge with them so that they have the tools they need to care for somebody through the end of their life. It’s a lot of education and making sure that all of our interdisciplinary staff are engaging with theirs to be collaborative partners together.”

Hospices can demonstrate their value proposition in part through their potential to prevent unnecessary hospitalizations and emergency department care, Errer added. Consequently, patient data have become key indicators of quality and cost reductions, she stated.

“It’s about how we as the hospice support physicians in some of their initiatives, which can come down to payment structure and what kinds of data we can provide that shows how we’re helping to keep patients out of the hospital,” Errer told Hospice News. “When that referral comes in, it’s being able to get teams quickly to the bedside and work with the family to support them right away.”

Widening hospice referral streams

Hospices have been shifting their referral sources further upstream, increasingly focused on educating providers across the continuum about the value of their services, said Krista Newman, chief operating officer for NorthStar Care Community. 

Value-based payment systems are also influencing referral trends, particularly into physician offices, Newman said.

“The mentality in referral strategies and what we’re all focusing on across the hospice industry has changed,” Newman said. “When we’ve talked with physician offices and other providers in the past, it’s been about educating them. Now it’s really about the value-based care aspects that we bring and having those conversations about the value we provide. So those referral conversations are shifting, and that’s really important for these physicians to find good partners in hospices, because they’re measured on keeping people out of the hospital and providing a quality ending.”

Skilled nursing and assisted living facilities were the top two opportunities for referral growth, according to more than half of the Hospice News survey respondents.

About 9% of those hospice organizations indicated that hospitals would be a focus in 2024, down nearly a quarter (22%) from 2023’s survey.

Hospice News

Memory care and physician settings are garnering more attention, along with palliative care programs, according to Patricia McDaniel, chief business development officer of NorthStar Care Community. 

“Friends and families are roughly 30% to 35% of our referrals, and hospitals are very similar to that,” McDaniel told Hospice News. “Getting care to patients and families sooner is probably through a palliative vehicle and [getting] those patients transitioned to hospice when the time is right. It’s all referral sources, including memory care and physicians, and showing the value of talking to us sooner and getting to the bedside with urgency. We are experts at providing very complex care, and that’s a differentiator to add value to these referral sources.”