Hospice: Trends and Recommendations for Future Development

Caregiving Resource | April 02, 2019 | by Ruth Katz

A report recently published by LeadingAge, Nonprofit Hospice Services: Where Mission and Community Meet, discusses the development of hospice services over the past half century, current issues of quality assurance and financing, and recommendations for policy changes to make these services more accessible to people at the end of life.

LeadingAge, LeadingAge Ohio, and the National Partnership for Hospice Innovation collaborated on the development of the report.

The publication describes the genesis of hospice services in the nonprofit sector and the growth of the sector following Medicare's expansion to cover hospice in the 1980s. As the report points out, hospice was the first type of health care service taking an interdisciplinary team approach to care, with payment bundled on a capitated basis.

While the use of hospice services has grown, the report notes the continuing challenges to ensuring that people in need of hospice can take full advantage of it, with 28% of Medicare beneficiaries using the benefit enrolled for fewer than 7 days before death. The report points out the geographic variation in rates of hospice use, with 18% of Alaskan Medicare decedents having been in hospice compared to 59% of Medicare decedents in Arizona. In addition, the report discusses the change in the point of delivery of hospice services, which increasingly are provided in nursing homes or assisted living along with the home-based settings in which hospice traditionally has been provided.

As the number of hospice providers has grown, the Centers for Medicare and Medicaid Services (CMS) and other regulatory agencies have increased their oversight of quality of care and transparency in the use of public resources.

For the future, the report recommends several policy changes to strengthen the hospice sector and ensure that services are available to people at the end of life:

  • Ensuring that value-based insurance design under Medicare Advantage gives Medicare beneficiaries access to nonprofit, community-integrated hospice providers;
  • Full information for Medicare beneficiaries and their families on care options when they are faced with advanced illness;
  • Increased flexibility for care team composition in rural areas where healthcare workforce shortages are acute ;
  • Expansion of telehealth options in hospice.