Shaida Talebreza

Variability in Hospice Care at the Very End of Life

to the family. Medicare policy has focused on the provision of hospice care at “home” whether it is the patient’s home, an assisted living facility, or a nursing home. Regardless of the site of service, a key part of safely caring for patients is that the hospice professional staff provides ongoing assessment, monitoring, and education about the medical management of the imminently dying patient. Our findings raise concerns that black patients and nursing home residents receive less support in the last 2 days of life from hospice professional staff. In addition, persons dying on a Sunday were less likely to receive any visits in the last 2 days of life. However, recent changes to the Medicare hospice payment system may address these problems. Starting in 2016, Medicare will provide a service intensity add-on payment to hospices that provide visits during the last 7 days of life (on days the patient is receiving RHC services). The intent of the payment is to promote visits by professional staff at the end of life and to better align the payments hospices receive with the increased care and service requirements at the end of life for all dying patients and those who care for them.

A Perspective on Hospice Reform and Additional Caregiver Support-Reply.

Author Contributions: Dr Hsia had full access to all the data in the study and takes full responsibility for the integrity of the data and the accuracy of the data analysis. Study concept and design: All authors. Acquisition, analysis, or interpretation of data: All authors. Drafting of the manuscript: Hale, Tabas. Critical revision of the manuscript for important intellectual content: All authors. Administrative, technical, or material support: Hsia. Study supervision: Hsia.