Patients who leave hospice often live quite a while

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Although hospices are meant to care for patients who are expected to die within six months, some who are admitted are eventually discharged—and most discharged patients survive for at least several more months, new research shows.

U.S. investigators found that, among a sample of 139 patients who were discharged from a hospice, 65 percent were alive six months later.

Study author Dr. Jean S. Kutner explained that she and her colleagues decided to conduct this study after speaking with hospice administrators, who often struggle to justify keeping patients under their care when they appear to be improving. Inevitably, some of those patients are discharged, and anecdotal evidence has shown that many die soon after.

However, these findings suggest that, in the majority of cases, patients are discharged from hospice for the right reasons, Kutner told Reuters Health.

“There were patients who died (soon after discharge), but there was also a big segment of this population who didn’t,” said the researcher, who is based at the University of Colorado Health Sciences Center in Denver.

These findings, reported in the Journal of the American Geriatrics Society, also demonstrate how difficult it is to predict how long patients with different conditions will live, she said.

For instance, although the amount of time a patient has left can be estimated by using the average life expectancy for patients with similar conditions, individual patients can have widely varying experiences, she said.

For that reason, Kutner said, hospice administrators should not be afraid to discharge a patient that they truly believe is improving, and patients and their families should not think of hospice care as something they will necessarily need for the rest of their lives.

“You can be admitted to hospice, take advantage of the services, and if you happen to be doing better, that’s great,” she said in an interview. “We’ll discharge you and readmit you later if you need it.”

In 2001, one in four people who died in the U.S. used some type of hospice care. To be eligible for the Medicare Hospice Benefit, patients need to have a terminal disease with a six-month life expectancy, at most.

Each year, between 6 and 8 percent of hospice patients are discharged, often because their condition was either stable or improving.

To investigate whether or not hospice patients are being discharged appropriately, Kutner and her colleagues followed 164 discharged hospice patients monthly for six months. Their terminal conditions included cancer, heart disease, dementia, and old age.

Only 35 percent of discharged patients died during the study period, and most of them - nearly 70 percent - were readmitted to hospice before they died.

Discharged patients who died passed away an average of 86 days after discharge.

The study results suggest that hospice officials should follow-up with discharged patients frequently, particularly during the initial days after discharge, Kutner and her colleagues conclude.

SOURCE: Journal of the American Geriatrics Society, August 2004. 

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