Hospice Live Discharge Problems (Research, Video 1:36)

Sometimes people really do leave hospice alive. That may or may not be a good thing. Discharges include patients deciding to resume curative care, improved patient conditions beyond hospice guidelines, or hospices inappropriately using live discharge to avoid costly hospitalizations. Discharges vary among hospices and geographic regions. Connecticut has the lowest rate, and Mississippi has the highest. Not-for-profit hospices and older hospices have lower rates of live discharge.

Not much has been known about how hospice live discharges vary by hospice providers' tax status and chain affiliation. This lack of knowledge prompted research to characterize hospices with high rates of problematic patterns of live discharges. Three hospice-level patterns of live discharges were defined as problematic when the facility rate was at the 90^th percentile or higher. They were the following:

1)  “Burdensome transition” including a high rate of patients discharged, hospitalized, and readmitted to hospice and considered to have a problematic live discharge pattern

2)   Live discharge patterns in the first seven days of a hospice stay

3)   Live discharge after 180 days in hospice

Research results conclude that each proposed problematic pattern of live discharge varied by chain affiliation. For-profit providers without a chain affiliation had a higher rate of burdensome transitions than did for-profit providers in national chains. Not-for-profit providers had the lowest rate of burdensome transitions. Clearly, this problem needs to be continually addressed at governmental levels, particularly in terms of patient care and questionable practices regarding discharging patients to save money or enrolling them to make money.

This video presents reasons why burdensome transitions are exactly what they are called. Healthcare transitions, such as moves from a nursing home to a hospital, can result in medical errors, lack of care coordination, and emotional distress and agitation for persons with advanced dementia. These transitions are not consistent with goals of providing dying patients with comfort care.

Frances Shani Parker, Author

Becoming Dead Right: A Hospice Volunteer in Urban Nursing Homes is available in paperback and e-book editions in America and other countries at online and offline booksellers.

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