BACKGROUND: Palliative care services are limited for patients with advanced illness and if they do not qualify for or do not wish to enroll in the Medicare Hospice Benefit. The frequency with which hospice agencies provide care to such individuals in a "pre-hospice" program is not known.
OBJECTIVE: This study surveyed hospice agencies throughout the United States to determine the prevalence and characteristics associated with establishing pre-hospice programs.
DESIGN: A questionnaire was distributed by e-mail to hospice agencies affiliated with the Practice-based Palliative Care Research Network (PoPCRN).
RESULTS: Of 42 hospice agencies responding to the questionnaire, 57% (24/42) currently have a pre-hospice/palliative care program. Among the agencies without a pre-hospice/palliative care program, 47% (8/17) were in the process of developing a program and only one hospice previously had a pre-hospice/palliative care program that had been discontinued. When asked if the pre-hospice/palliative care programs were profitable, 67% replied, "no;" only one program reported that the program was profitable. The agencies reported that less than half of the pre-hospice/palliative care patients went on to enroll in their hospice program. Lengths of service in hospice were not longer among patients who were referred into the hospice following enrollment in the pre-hospice program compared to patients who enrolled in the hospice program without first enrolling in the pre-hospice/palliative care program.
CONCLUSIONS: The majority of hospice agencies surveyed had established pre-hospice/palliative care programs and of those without programs, nearly half planned to establish a program in the near future. The programs were not perceived as profitable and did not increase length of hospice services yet most agencies maintained the pre-hospice/palliative care progams because they felt this service filled an important gap in end-of-life care.
For more information on this study, please contact:
Cari Levy, MD
Cari.Levy@ucdenver.edu