Factors That Influence Interruption in Hospice Home Care Services

Background: Research on outcomes in hospice indicates that there are more positive outcomes in terminally ill patients who receive hospice care than those who do not receive this specialized care (Harper, 2011). There continues to be a difference in the utilization of this care with patients who have been admitted to hospice, and remain eligible but often leaving and returning more than one time during a single certification period. For the purposes of this paper, this type of live discharge is referred to as an interruption in hospice home care.   While reasons for leaving hospice alive may be positive in some aspects i.e., the disease is not progressing and a decline in health status is not present, other discharges may result in the inability to receive symptom control, leaving patients vulnerable to suffer through unmanaged end of life symptoms and die in pain. The trend of live discharges is seen in hospices across the US often with enrollees electing not to return to hospice home care (Johnson, Kuchibhatla, Tanis, & Tulsky, 2008). In 2012, 15.9% of hospice patients served were discharged alive (NHPCO, 2013). 

Methods: The focus of this retrospective data analysis was hospice patients and a set of related factors that may inform patterns of utilization of hospice home care. Queries of the hospice medical information database on live discharges and those who died during the years 2010 to 2011 yielded 5,125 records. The Health care utilization model for vulnerable populations adapted by Gelberg, Andersen, and Leake (2000) supported the analysis of variables categorized within the domains of predisposing, enabling, and need to assess influences to decisions made about end of life care.   Gelberg et al. suggest that variable categorization within suggested domains can predict health behavior outcome, the interruption in hospice home care services.

Research question:How do variables categorized as predisposing, enabling, and perceived need influence interruptions in hospice home care services?

 

Hypothesis:The predisposing, enabling, and need factor variables will significantly predict the likelihood of interruptions in hospice home care.

Results:  Findings from this study suggest that the type of religious practice, financial status of the patient, and the presence of other home care services such as a personal care assistant, are directly related to the patient’s behavior toward the utilization of hospice care.   

 

Conclusion/ Implications:  This information contributes to the overall understanding of behavior toward end of life care in vulnerable populations, leading to an opportunity for the development of effective methods of engagement that support continuity of end of life.   Development of a community based educational program about end of life care in vulnerable populations may lead to the reduction of barriers that currently exists between hospice organizations, patients and families (Johnson, 2013) leading to a decrease in disparities in palliative care.  Hospice social workers can use this information to bridge communication gaps through community outreach, education of the hospice agency professional, and by increasing information to the patient and family.