In Vermont, hospice use is particularly low. National Medicare hospice utilization trend data through 2012 indicated that Vermonters were less likely to use hospice services than residents of other states, and they used fewer days of care.
In October 2014, the UVM Health Network – Home Health & Hospice of Chittenden and Grand Isle Counties’ Madison-Deane Initiative, the education arm of UVM Health Network – Home Health & Hospice End-of-Life Care services, commissioned a study with support from the UVM Health Network – Home Health & Hospices of Vermont and a grant from Coverys Community Healthcare Foundation to examine hospice utilization in Vermont.
The purpose of the study was to deepen our understanding of the barriers to hospice specific to Vermont and to identify opportunities for ensuring Vermonters experience quality end-of-life care.
The study found a combination of factors is contributing to lower use, including a need for increased education for health care providers and patients and families, as well as more support for the advance care planning process.
In addition, healthcare providers identified barriers in referring patients with certain illnesses to hospice, particularly patients with cancer and dementia. In fact, 2012 Medicare claims data revealed Vermont patients with cancer diagnoses used hospice at half the national average; these patients were more likely to die in hospitals than their counterparts in more than 40 other states. Cancer is the leading cause of death among Vermonters and Vermont death rates for both cancer and dementia are higher than the national average.
“This study has helped us to see where we should focus. It is reassuring to know that addressing the challenges is within our reach,” said UVM Health Network – Home Health & Hospice President and CEO Judy Peterson. “The next step will be to engage with our partners to discuss where our resources can be most effective in driving change and what we can do together to systemically change our practices.”
The study focused on five areas that may contribute to low utilization and short stays:
- Reluctance of providers to refer to hospice
- Low use by residents of nursing homes
- Low use by people with specific diagnoses
- Limited knowledge or capacity of families
- Availability of resources used by hospice providers
This study was guided and overseen by a Study Advisory Committee that included physicians, hospice agency staff, policy makers, consumers, and faith communities. Committee members from diverse backgrounds and regions of Vermont were recruited to include perspectives on local cultural norms and healthcare.
The full report can be downloaded here.