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Hospice Patients rarely get a Medical Visit in the Last Two days of Life, Study Says

Update Date: Feb 09, 2016 11:44 AM EST

Hospice patients receiving end-of-life care rarely get a visit from a medical professional within the last two days of life, a new study is reporting.

For this study, the research team headed by Dr. Joan Teno, professor of medicine at the University of Washington in Seattle, examined the level of care that hospice patients living at home or in a nursing home received in their final days.

According to HealthDay, reported by Philly.com, the team decided to focus only on the last two days "because symptoms escalate and pain worsens for patients who are cared for by families, and families need to be educated about how to care for the patient. Also families need support not only in the task of being the hands-on primary caregiver, but also bearing witness to the death of a loved one."

The team analyzed data on 661,557 Medicare patients who filed claims during the federal fiscal year of 2014. Out of this group of patients, 81,478 of them (12.3 percent) did not have a visit from a medical professional in their final two days of life. The researchers noted that variations existed by state. For example, if you lived in Alaska or Washington, the chances that you would see a medical professional in your final days were extremely low compared to other states.

When the researchers analyzed 3,448 hospices involved in the study, they found that 281 programs (8.1 percent) did not offer visits by a member of the medical community within the two last days of life. Only 21 hospice programs (0.6 percent) offered visits to all of their hospice patients.

The team also found that one's likelihood of receiving a visit right before death was affected by race, location of care and the date of the week.

Black patients and patients living in nursing homes were the least likely to receive visits. Patients who died on Sunday also had a lower chance of getting a visit. Smaller hospice programs also had lower visit rates.

The researchers stressed the importance of getting visits during the final days of life for the patient and the patient's loved ones.

"They can make changes to ensure that the dying patient is comfortable and to provide education to the family on how to care for the patient in the last days of life," Teno said.

The study's findings have led to a change in the U.S. Centers for Medicare and Medicaid Services' hospice care payment policy. The change, which started on Jan. 1, 2016, included a "service intensity add-on payment" that allows hospice patients who are in their final week of life to receive up to four hours per day of visits by a registered nurse or medical social worker.

Prior to this chance, Medicare paid a single rate for each patient regardless of the number of visits that the patient received by a registered nurse, social worker or any other members of a professional staff

The study, which was funded by the Centers for Medicare and Medicaid, was published in JAMA Internal Medicine.

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