Hospice Services in Rural Areas Can Reduce Need for More Expensive Services

Medical services that are designed to reduce pain and discomfort for the dying may also reduce the demand for more expensive treatments, a new study says.

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Expanding the use of hospice services among rural residents in the last six months of their lives could reduce patients’ need for more expensive and inconvenient medical treatments, a new report suggests.

About 44% of rural Medicare patients who died in the second half of 2013 used hospice services, according to the study. By comparison, just over half of urban Medicare patients at the same stage of life used hospice services.

The study was released by the South Carolina Rural Health Research Center and was based on a sample of Medicare records.

Patients who use hospice services are less likely to visit a doctor’s office, be admitted to hospitals, or require an ambulance, the study said. That can save money and allow patients to spend less time going to and from appointments and undergoing exams and treatments.

The biggest difference between hospice and non-hospice patients was in their use of skilled nursing facilities. Rural Medicare patients who did not receive hospice care were 22% more likely to use a skilled nursing facility than patients who did get hospice care (21.7% vs. 26.4%). The difference was less pronounced but still obvious for urban patients. For them, non-hospice patients were 12% more likely to use a skilled nursing facility than patients who received hospice care (22.4% vs. 25.0%).

Both urban and rural non-hospice patients were less likely to receive in-home health-care services.

“Participation in hospice care was found to reduce the likelihood of inpatient, SNF, and ambulance use, while being linked to a greater probability of home-based care,” the study said. Home care can be less expensive than office visits and reduce more expensive services such as ambulance transportation and hospital admission. (Other recent research describes some of the unique challenges that stand in the way of delivering home-health services in rural areas.)

“Lower use of hospice services among rural residents may represent an opportunity to further reduce [the use of] acute services,” the study said.

But getting access to hospice care in rural areas can be problematic, according to the Rural Health Information Hub (RHIhub), a national clearinghouse for information on rural health.

“In rural areas, providing hospice and palliative care includes challenges such as lack of available family caregivers, financial reimbursement issues, lack of qualified staff, and travel distances,” RHIhub states in its topic guide on hospice and palliative care.

Proportion of Medicare Beneficiaries with Hospice Use during the Last Six Months of Life by
Race/Ethnicity and Residence, 2013

Nevertheless, the use of rural hospice care has grown rapidly in the last 15 years. The percentage of potentially eligible rural Medicare patients who used hospice grew by more than 140% from 2000 to 2014. During the same period, usage grew by about 100% for urban residents.

About a quarter of the nation’s 4,100 hospice-care programs are located in nonmetropolitan counties, according to the report.

Hospice care was developed during the second half of the 20th century to treat patients with terminal conditions. The care focuses on relieving symptoms that cause pain and discomfort, rather than trying to defeat the underlying illness. Patients may undergo hospice care in their home, a hospital, a nursing home, or a dedicated hospice facility. Frequently, family members care for the patient directly with support from hospice-care staff.

About 1.2 million Americans received hospice care in 2014, a year when there were 2.6 million deaths, according to the National Hospice and Palliative Care Organization and the Centers for Disease Control.

Whites were more likely than other races and ethnicities to use hospice care. Urban patients who were white and African American were more likely to use hospice than rural patients of the same race. But rural Hispanic Medicare patients were more likely to use hospice than their urban counterparts.

The study was conducted by Elizabeth Crouch, Ph.D., Kevin J. Bennett, Ph.D., and Janice C. Probst, Ph.D. and released by the South Carolina Rural Health Research Center.

 

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