| Popis: |
Hospice care for persons with dementia is slowly evolving as the public understands of the nature of the disease, clinicians improve their abilities to assess prognosis for late stage dementia and funders understand the financial wisdom of hospice care. Medicare utilization of hospice services in 2009 by patients with dementia increased to 6 % of hospice admissions for persons with Alzheimer’s disease and 11 % of all admissions for persons with dementia other than Alzheimer’s disease e.g., Lewy body dementia. Length of stay in hospice for persons with Alzheimer’s disease expanded from 67 days in 1998 to 106 days in 2009 [1]. The LOS for non-AD dementia increased from 57 days to 92 days. The extended LOS has produced a tenfold increase in Medicare expenditures from $184 to $1,880 per recipient with dementia. The number of hospice agencies that serve patients with dementia increased from 21 % of providers in 1994 to 94 % in surveys from 2008 [2]. A survey of 16,347 nursing homes in the US revealed a significant increase in the number of demented residents who used hospice from 26.5 % in 2003 to 34.4 % in 2007 [3]. Most patients with dementia have complex care needs in the final stages of the illness. In contrast to the hospice expenditure, the cost of assisted living care is approximately $3,600 per month while the cost of nursing home care is about $255 per day. Long term care for dementia in any setting is expensive however the modest cost of hospice care coupled with potential savings from avoiding unnecessary hospital admissions points to the relative value of hospice care [1]. For-profit hospice agencies are more likely to take patients with dementia; these individuals frequently have lower “skilled needs” and longer length of stay [4]. |
