Presenter: Evan Sangster, College of Social and Behavioral Sciences, Health, Society & Policy
Authors: Evan Sangster
Faculty Advisors: Rebecca Utz, College of Social & Behavioral Science, Sociology; Katherine Supiano, College of Nursing, Gerontology
Institution: University of Utah
Hospice is a type of team-delivered health care, focused on the delivery of palliative (in contrast to curative) care for terminally ill patients and their families. Most hospice is provided under the Medicare hospice benefit which sets the conditions of participation in hospice as having a life expectancy of 6 months or less to live. Compared to those with cancer -the illness for which hospice originally catered to- patients with Alzheimer’s disease and related dementias (ADRD) are at an increased risk of a “live hospice discharge” due to the uncertain prognosis and trajectory of these diseases. Live hospice discharge occurs when a patient outlives the 6-month eligibility criteria; it lowers the quality of life and increases the burden for both the patient and the patient’s family. Our research objective is to formulate a policy recommendation that will reduce the incidence of live hospice discharge in patients with ADRD. To do this, we analyze policies and regulations as they relate to hospice eligibility criteria and as are currently implemented by Centers for Medicare and Medicaid (CMS). The policy analysis follows the systematic steps of the CDC’s Polaris Policy Process. This first requires identification of the problem and its effect on the population. This is followed by identification and comparison of alternative policy options and presentation of a recommended policy solution that best balances the unique needs of ADRD patients wanting to utilize hospice care during the end-of-life period. While several policy changes have occurred over the last 10-15 years, the most recent amendments have only further exacerbated this issue. The frequency of live hospice discharge will become an increasingly important topic as ADRD patients continue to grow in proportion to the total hospice patient pool and as the population grows older as a whole.