Trends in Social Service Utilization for Veterans Receiving Hospice Care

Purpose: Hospice is a major expansion area within the Veterans Administration (VA) to meet the needs of a growing population of frail older veterans at the end of life. The veteran population is unique, differing substantially from the general population in key demographic areas such as gender and age. This has implications for available services and overall care provided in the VA system. One important component of hospice care is provision of social services, and social workers play a key role in meeting end-of-life needs. Services may be provided either in a VA healthcare setting or through home based services designed to serve complex, chronically ill veterans. The objective of this research is to utilize VA data to evaluate hospice utilization and social services provided to veterans receiving hospice at the end of life and explore trends in service utilization across time.

Methods: Using the national dataset of all veterans enrolled in the VA healthcare system from fiscal years 2006-2009, the number of veteran patients receiving hospice services across age groups, average total cost per patient, and average total cost per hospice visit, were identified. Receipt of social work services was then added as a criterion for inclusion and the number of hospice patients receiving social services, the average total social work cost per patient, and the average total social work cost per visit, were obtained. Finally, to explore social work services provided through home based services, data was extracted on number of patients receiving home based services, average total cost per home based patients, and average total cost per sock work visit.

Results: In 2009, the number of veterans age 55+ receiving hospice services was 6,035, over three times the number receiving hospice in 2006. The average cost per hospice visit across age groups 55+ ranged from $409.80 to $497.72. Of interest, the average cost per patient decreased across age groups from $1,251.51 to $805.98. The number of veterans on hospice receiving social services in 2009 increased over five times from 2006 to 684 veterans. The average cost per social work visit ranged from $541.95 to $756.80 across age groups. Similar to overall hospice patient cost, the average cost per social work visit decreased across age groups from $962.17 to $864.21. Home based social services increased over two times between 2006 and 2009 to 5,730 visits. The average cost per home based service ranged from $345.63 to $367.59 across age groups. In line with hospice and social service costs, the average cost per home based visit decreased across age from $973.92 to $920.32.

Implications: A substantial increase in service utilization for hospice and social services is evident between 2006 and 2009. It appears this trend will continue in the future as veterans become older, increasingly frail, and require more services. This will require the VA to invest more funds and supportive infrastructure to meet growing demand. It also highlights the important, growing need for social workers within the VA to provide crucial supportive services at the end of life.