Trends in Hospice Referral and Length of Stay at a Veterans Hospital Over the Past Decade

Introduction: Hospice decreases the fear of dying alone, reduces the agony of death, and helps in maintaining dignity at the end of life. Physicians are encouraged to offer hospice to terminally ill patients early on in their end-of-life care to maximize these benefits. However, there is limited data on the changes and characteristics of hospice utilization.We performed a study to determine the changes in the hospice utilization over the last decade in our hospital. Methods: A chart review of all veterans referred to hospice during the years 2001 and 2010 was performed and subsequently analyzed. Analyses were performed with SPSS 19.0 for Windows. Results: Referral to hospice increased significantly but the duration of stay did not change in 2010 in comparison with 2001. Factors associated with increased length of stay were full-code status, receiving hospice at home, hospitalization during enrollment in hospice, referral to hospice by oncologist, and a diagnosis of cancer. Conclusion: Hospice referrals need to be considered earlier in their disease process for terminally ill patients. In addition, requirement of a donot- resuscitate order as a condition for hospice at some agencies needs to be revisited, and patients should not be discouraged to seek treatment for reversible medical conditions even when enrolled in hospice.