End-of-Life Care in the USA

The National Hospice and Palliative Care Organization (NHPCO) issued its annual report on hospice care in the USA during its annual meeting on October 27-29, 2014. The NHPCO reported that 1.5 to 1.6 million patients received care from hospice programs in the USA in 2013, and this number was consistent with data from 2012. About 37% of patients had a diagnosis of cancer and the remainder of patients included those with other diseases, such as heart and lung disease.

The NHPCO’s publication, Facts and Figures: Hospice Care in America reports on hospice trends and provides updated information on the growth, delivery, and quality of hospice care in the USA. The full report is available on NHPCO’s website at http://www.nhpco.org/press-room/press-releases/new-report-hospice-care-us. A major finding, and major concern of hospice and palliative care professionals, was that 34.5% of patients died or were discharged within seven days of admission to hospice care. The organization concluded that that many patients are opting for hospice care but are receiving it far too late in the course of their disease. Additional findings included a median length of service of 18.5 days, and that 66% of hospice care was provided in the home setting (defined as a private residence, nursing home, or residential facility). The Medicare Hospice Benefit covered 91.2% of hospice care in 2013, so lack of payment for hospice services is not the reason why so few are referred so late. The obvious take-home message is that earlier referral is needed to promote comfort at the end of life.