Does Hospice Improve Quality of Care for Persons Dying from Dementia?

Abstract

OBJECTIVES To examine the effectiveness of hospice services for persons dying from dementia from the perspective of bereaved family members. DESIGN Mortality follow-back survey. SETTING Death certificates were drawn from five states (AL, FL, TX, MA, and MN). PARTICIPANTS Bereaved family members listed as the next of kin on death certificates when dementia was listed as the cause of death. MEASUREMENTS Ratings of the quality of end-of-life care, perceptions of unmet needs, and opportunities to improve end-of-life care. Two questions were also asked about the peacefulness of dying and quality of dying. RESULTS Of 538 respondents, 260 (48.3%) received hospice services. Family members of decedents who received hospice services reported fewer unmet needs and concerns with quality of care (adjusted odds ratio (AOR) = 0.49, 95% confidence interval (CI) = 0.33–0.74) and a higher rating of the quality of care (AOR = 2.0, 95% CI = 1.53–2.72). They also noted better quality of dying than those without hospice services. CONCLUSION Bereaved family members of people with dementia who received hospice reported higher perceptions of the quality of care and quality of dying.

Family Caregiving and the Site of Care: Four Narratives About End-of-Life Care for Individuals with Dementia

“…Having music available, gentle lighting, and pleasant views to the outside make both patients and family members feel better. Consideration should be given to adding the role of the environment to earlier models such as the patient-and family-centered perspective as outlined by Teno and associates (Teno, 2000;Teno, Casey, Welch, & Edgman-Levitan, 2001;Teno et al, 2011).…”

House Calls: The Impact of Home-Based Care for Older Adults With Alzheimer’s and Dementia

“…This is especially true for patients with dementia, who were three times more likely to have hospice expenditures than matched controls; among the total sample, cases were only twice as likely to have hospice expenditure than controls, suggesting increased use of endof-life care for House Calls patients with dementia. Some evidence suggests that patients with dementia who receive hospice care have better quality of life and fewer unmet needs at the end of life than those who do not receive hospice (Albrecht et al, 2013;Miller, Mor, Wu, Gozalo, & Lapane, 2002;Teno et al, 2011). Patients receiving hospice care at home also have shown improved quality and greater satisfaction with care and lower health care costs than those receiving home-based care that does not include hospice (Candy, Holman, Laurent, Davis, & Jones, 2011).…”

Dying in the Age of Choice

“…Although hospice care is associated with a better quality of dying (Teno et al, 2011), in 2012, just 12% of hospice users were enrolled for the duration of the initial benefit period (6 months) and more than one-third (36%) were enrolled for less than 1 week and nearly two-thirds (63%) were enrolled less than 1 month (NHPCO, 2013). In terms of eligibility, services are limited to those with a qualifying prognosis of a life expectancy of 6 months or less; which is difficult to predict among older adults due to the multiplicity of chronic conditions and variability between persons (Gill, Gahbauer, Han, & Allore, 2010).…”