The High Costs of Limited Hospice Access for Dementia Patients 

Limiting hospice access for dementia patients is likely to increase overall health care costs at the end of life, according to recent research.

During the past decade, Medicare beneficiaries with dementia who utilized hospice had lower overall health care costs than those who did not, according to the Health Affairs study.

The findings provide a window into the impacts of longer hospice stays for dementia patients at a time of heightened regulatory attention around utilization and costs in Medicare, according to the researchers from the Icahn School of Medicine at Mount Sinai, the James J. Peters Bronx Veterans Affairs Medical Center and the University of California San Francisco.


“Policy makers in the U.S. are increasingly concerned that greater use of the Medicare hospice benefit by people with dementia is driving up costs,” researchers wrote in the study. “Yet, this perspective fails to incorporate potential cost savings associated with hospice.”

Researchers recently examined Medicare beneficiary survey data from 2002 through 2019 to determine the health care costs associated withindividuals with dementia nearing the end of life.

Compared to those who did not utilize hospice, Medicare costs were lower for community-based dementia patients enrolled in these services within the last three days of life by as much as an estimated $2,200 and roughly $7,200 in the last three months of life, the study found.


Total health care and Medicare costs were also lower for dementia decedents who utilized hospice a month prior to death compared to others, researchers found.

Neurodegenerative and neurologic diseases are among the fastest growing dianoses among hospice and palliative care patients.

About 1 in 9 (10.8%) of seniors 65 and older in the United States will have some form of Alzheimer’s or dementia by 2050, according to a report from the Alzheimer’s Association. That percentage rises with age, as nearly three-quarters of individuals 75 and older have dementia, the report found.

Patients with dementia often have longer hospice stays and require more intensive and expensive levels of care compared to others.

Length of stay represents an area of concern in the hospice payment and regulatory landscape. Regulators often see longer stays as among the red flags that can lead to an audit by Medicare contractors.

The U.S. Centers for Medicare & Medicaid Services (CMS) has increasingly placed length of stay in the forefront, announcing in July a plan to conduct post-payment medical reviews of hospice stays longer than 90 days.

Data that show positive correlations between lower heath care costs and longer hospice stays could help provide regulators with a better understanding around the full scope of access and utilization among dementia patients, the Health Affairs study researchers indicated.

“Medicare policies that reduce hospice access and incentivize hospice disenrollment may actually increase Medicare costs, given that hospice cost savings generally derive from a person’s last days or weeks of life,” the researchers said.

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