Hospice by the numbers
Deaths
2.45 million people died in the U.S. 1.58 million people received hospice care, which represents a 1.2% increase from 2009. 1.03 million people died under hospice care, representing 42% of all deaths. 259,000 people were discharged from hospice (for extended prognosis, curative treatment, etc.) 292,759 people remained on hospice care from 2010 as of December 31st.
Length of Care
The average length of time that a person received hospice care was 67.4 days, and the median (50th percentile) length of stay was 19.7 days. Lengths of stay have been decreasing slightly over the past few years.
Discharges and Deaths
Within 7 days – 35.3%
Within 14 days – 49.4%
Within 30 days – 62%
1-3 months – 17.2%
3-6 months – 8.7%
After 6 months – 11.8%
Place of Care
Most people, 66.7% remained in their current “home” to receive hospice care (private residence, nursing home or other facility): 41.1% of patients received hospice care at their own house; 18% in a nursing home; 7.3% in another residential facility (ie: assisted living). 21.9% of patients moved to an inpatient hospice facility, and 11.4% received hospice care in a hospital. Inpatient and hospital-based hospice care increased slightly from 2009.
Demographics
Hospice care is used fairly evenly by men and women. 56.1% of hospice patients were women, while 43.9% were men. 38.9% of hospice patients were older than 85, 43.8% were between 65 and 85, and 17.4% of all hospice patients were younger than 65. In total, 82.7% of patients were older than 65. 77.3% of hospice patients were Caucasian, 5.7% were Hispanic or of Latino origin, 8.9% were Black or African American, 2.5% were Asian or Pacific Islander, 11% were multiracial and 0.3% were Native American or Alaskan Native. Hospice care among non-Caucasian people of all ethnicities increased in 2010.
Diagnoses
The most common diagnosis among hospice patients was cancer, representing 35.6% of diagnoses, a significant decrease from 2009. Among non-cancer diagnoses, 14.3% of patients had an heart disease and 13% had dementia or an unspecified debility. Lung disease, stroke, kidney disease, ALS, liver disease and HIV/AIDS were other common diagnoses. Hospice use for diagnoses other than cancer has increased over the past few years.
Care Providers
There are approximately 5,150 hospice programs in all fifty states, including multiple locations of the same organization. Hospice programs have been increasing by approximately 150 per year since 2006. 58% of hospice providers are independent, hospice-only agencies; 21.3% are part of a hospital system; 19.2% are part of a larger home health agency; 1.4% are part of a nursing home.
79.1% of all providers had fewer than 500 new admissions over the course of the year, while 4.6% had more than 1,500 admissions. Most hospices (63.1%) had 50-500 admissions. 69% of hospices cared for 1-100 patients per day, while 31% cared for more than 100 per day. 36% of providers were not-for-profit, 58% were for-profit, and 6% were government agencies. Approximately 93.3% of all providers are Medicare- certified.
Paying for Care
83.8% of patients were covered by the Medicare Hospice Benefit; 7.9% were covered by long-term care insurance, 4.9% were covered by the Medicaid Hospice Benefit, 1.5% was paid for by charity, and 1.1% of patients paid privately.
Type of Care
95.7% of care days were routine home care, 2.9% was general inpatient care, 1.2% was continuous care, and 0.2% was respite care. Continuous care increased slightly in 2010.
An average of 2 family members per hospice patient received bereavement support through the hospice provider. 92% of hospice providers offer some level of community grief service.
Care Providers
70.7% of full-time hospice employees provided direct patient or bereavement care. 30.1% of all hospice employees were nurses and 19.4% were home health aides. On average, each home health aide cared for 10.5 patients, each nurse case manager cared for 10.9 patients and each social worker cared for 24.3 patients. 21.9% of hospice employees were administrative or non-clinical.
458,000 volunteers provided 21 million hours of service for hospice providers. 59.3% of volunteers provided direct patient care, and 21.5% provided administrative or indirect patient support. The average volunteer fulfilled 46.7 hours and made 20 visits to hospice patients.
Quality of Care
75.6% of families rated their hospice care “excellent”. 77% said their bereavement needs were met “very well”. 72.5% said the patient’s level of pain was managed within 48 hours of admission.