Facility Placement as a Barrier to Hospice for Older Adult Patients Discharged From a Palliative Care Unit.
Myrick C Shinall, Jo Ellen Wilson, Mohana Karlekar and 1 others
PMID 30064237WHAT IT FOUND
Older adults needing facility placement at discharge were significantly less likely to enroll in hospice than those returning home.
The financial barrier of paying for room and board in facilities appears to impede hospice access for patients who would otherwise qualify.
Key findings
01Hospice enrollment was significantly lower for patients discharged to a healthcare facility compared to those discharged home.
02Discharge to home was associated with six times the odds of hospice enrollment compared to facility discharge, even after adjusting for covariates.
STILL TO COME
How it was doneWhat they foundWhat it means for RNs
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What it does not show
The study did not capture hospice enrollment that occurred after discharge, so patients who enrolled later were counted as non-enrolled at discharge. Causality is unclear: patients desiring life-prolonging care or rehab might choose facility placement independently of hospice availability. The database did not contain data on the specific reasons patients did not enroll in hospice, so the financial barrier is inferred rather than directly measured. The study was conducted at a single tertiary academic referral center, which may limit generalizability.
Declared interests
None reported in the provided text.
The easy way to misread this
Do not conclude that facility placement directly causes hospice avoidance. The study design cannot prove causation, as patients' goals for life-prolonging care may have influenced both their discharge destination and their decision to enroll in hospice.