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Hospice Care Is Being Started Later

WASHINGTON (AP) — Terminally ill patients are spending fewer of their last days in hospice care, advocates of better care for the dying said in a report Monday.

Last Acts, a coalition of health and aging groups, looked at the availability of good end-of-life care. One central measure is hospice care, which provides dying patients with such services as pain relief and assistance in putting their affairs in order. It usually is offered in patients' own homes, and Medicare pays for it.

More people are turning to hospice care, the report said. Enrollment jumped from about 1,000 a year in 1975, when hospice care began, to 700,000 in 2000.

But they are entering hospice care ever closer to the time of death. Patients spent an average of 70 days in hospice care in 1983, but that dropped to 36 days by the late 1990s, the report said. In 1998, 28 percent of hospice patients were enrolled for one week or less before they died.

Hospice care varies widely by state. In 2000, hospice was most popular in Arizona, where between one-third and half of patients over age 65 used it during their last year of life. It was least popular in Alaska and Maine, where less than 10 percent of the dying elderly used it.

Medicare pays for hospice for patients considered likely to die within six months, and Last Acts cited studies suggesting patients must participate for at least 60 days to get the maximum benefit.

In 2001, the report said, hospice stays for patients of any age were longest — a median of 45 to 60 days — in Alabama, Louisiana, Mississippi, New Mexico, North Carolina and South Carolina.

It's not known why hospice time is dropping, although recent studies have found it is harder to predict remaining life expectancy with certain diseases. Some cancers, for instance, progress steadily while other diseases, such as heart failure, may wax and wane.

Members of Congress two years ago called the decline in hospice lengths of stay troubling. They urged Medicare to remind doctors that if a patient lives longer than the six months initially expected, recertifying that he or she remains close to death ensures that payment continues.

Medicare officials issue periodic reminders explaining that, but it still causes confusion, said Judith Peres, co-author of the report.

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