Hospice Referral After Inpatient Psychiatric Treatment of Individuals With Advanced Dementia From a Nursing Home

1. Gary Epstein-Lubow, MD1,2⇑
2. Ana Tuya Fulton, MD, FACP1,2
3. Louis J. Marino, MD1,2
4. Joan Teno, MD, MS1,3

1. ¹Brown University, Providence, RI, USA
2. ²Butler Hospital, Providence, RI, USA
3. ³Rhode Island Hospital, Providence, RI, USA

1. Gary Epstein-Lubow, Psychosocial Research Program, Brown University, Butler Hospital, 345, Blackstone Boulevard, Providence, RI 02906, USA. Email: gary_epstein-lubow@brown.edu

Abstract

This report addresses the discharge disposition following inpatient psychiatric treatment for advanced dementia. The total population included 685 305 Medicare fee-for-service decedents with advanced cognitive and functional impairment, with a mean age of 85.9 years who had resided in a nursing home. In the last 90 days of life, 1027 (0.15%) persons received inpatient psychiatry treatment just prior to the place of care where the individual died. 

Discharge dispositions included 132 (12.9%) persons to a medical hospital, 728 (70.9%) to nursing home without hospice services, 73 (7.1%) to hospice services in a nursing home, 32 (3.1%) to home without hospice services, and 16 (1.6%) to hospice services at home. Overall, the rate of referral to hospice services for advanced dementia was relatively low.