ACCESS TO HOSPICE PROGRAMS IN END-STAGE DEMENTIA - A NATIONAL SURVEY OF HOSPICE PROGRAMS

OBJECTIVE: Because care of end-stage dementia is a significant clinica l problem for which alternative modes of care are needed, this study e xamined the extent to which hospice programs served dementia patients. DESIGN: A survey of 1694 hospices with 1184 respondents (70%). PATIEN TS: Identifed patients had end-stage dementia, with no concurrent term inal illness. MEASURE: The proportion of end-stage dementia patients i n hospice was measured. RESULTS: Fewer than 1% of hospice patients had a primary diagnosis of end-stage dementia, and only 21% of the hospic es served such patients. However, 7% of hospice patients had a dementi a secondary to another terminal illness, and 56% of the hospices serve d such patients. For 80% of the hospices, the major problem in serving dementia patients was the difficulty in predicting their survival tim e. A higher proportion of for-profit hospices served dementia patients (42%) compared with non-profit programs (22%) or public programs (15% ), P < .001. CONCLUSIONS: A national survey of hospices revealed that few patients with primary dementia are currently treated by these prog rams, unless they have other terminal illnesses. An inability to predi ct survival was the major reason offered to explain this phenomenon. T he higher percentage of patients with secondary dementia in hospice su ggests that dementia per se does not make hospice care unfeasible. Sim ilarly, the high proportion of for-profit hospices that enrolled patie nts whose dementia was primary implies the fiscal feasibility of provi ding hospice care for these patients. Further study is needed concerni ng the determinants of survival time in endstage dementia.