Survival in hospice patients with dementia: the effect of home hospice and nurse visits

Background Hospice patients with dementia are at increased risk for live discharge and long lengths of stay (>180 days), causing patient and family caregiver stress and burden. The location and timing of clinician visits are important factors influencing whether someone dies as expected, in hospice, or experiences a live discharge or long length of stay. Objective Examine how home hospice and nurse visit frequency relate to dying in hospice within the Medicare‐intended 6‐month period. Design Retrospective cohort study. Setting Non‐profit hospice agency. Participants Three thousand eight hundred and thirty seven patients with dementia who received hospice services from 2013 to 2017. Methods Multivariable survival analyses examined the effects of receiving home hospice (vs. nursing home) and timing of nurse visits on death within 6 months of hospice enrollment, compared to live discharge or long length of stay. Models adjust for relevant demographic and clinical factors. Results Thirty‐nine percent (39%) of patients experienced live discharge or long length of stay. Home hospice patients were more likely to experience live discharge or long length of stays (HR for death: 0.77, 95%CI: 0.69–0.86, p