What Factors Are Associated with a Longer Stay in Hospice Care?

Background/Purpose: The benefits of early referral to hospice services have been well documented. Despite this knowledge, late admissions and short hospice stays are ongoing issues that are often barriers to improving terminally-ill persons’ and their caregivers’ quality of life and quality of care. The purpose of this study was to investigate factors associated with the length of stay in hospice care by analyzing data from the largest hospice agency in the DC metro region. The significance of the study includes the large sample size that allows for a thorough analysis of patients’ length of hospice enrollment by comparing patient demographic/socioeconomic factors.

Methods: This study examined routinely collected patient data in a hospice agency focusing on patients who died in 2015 while receiving hospice care (N=7,307). The dependent variable was the length of stay in hospice care. Because this variable was highly skewed (skewness=3.61), it was categorized into four groups: shorter than seven days, between seven and 21 days, between 22 and 98 days, and 99 days or longer. Independent variables were age at the time of death, sex, race, income, and cancer diagnosis. Descriptive statistics were used to summarize chacteristics of diseased hospice patients. Ordered logistic regression was conducted to identify factors associated with the length of stay in hospice care.

Results: The median length of stay in hospice care was 23 days. Cancer diagnoses (p<0.01) and residence in a higher median income neighborhood (p<0.001) were associated with shorter lengths of stay. Female sex (p<0.01), older age (p<0.05), and residence in a lower median income neighborhood (p<0.01) were associated with longer lengths of stay.

Conclusions and Implications: The findings indicate that differences in demographic and diagnostic characteristics likely affect hospice length of stay. More specifically, patients with a cancer diagnosis and a relatively higher income might be referred to hospice later than non-cancer patients and patents with a relatively lower income. It is important for health care providers to be aware of these findings, and the timely hospice referral needs to be encouraged. Although patients suffering from cancer or those with monetary resources might seek aggressive treatment compared to non-cancer patients or patients with fewer monetary resources, they and their caregivers need to be informed of the benefits of hospice care.