Addressing the Gap: OT in Hospice Care

PURPOSE: Hospice care is an emerging area receiving increasing public attention. The growing needs are due to a combination of longevity and a raising rate of chronic disease. In 2016, nearly 1.43 million Americans received hospice care in 4,382 Medicare-certified hospice agencies.¹ A 2017 BMC Medicine study estimated 75% of people approaching the end-of-life could benefit from hospice care.² Hospice care addresses physical, emotional, psychosocial and spiritual needs and offers compassionate care to patients with end-of-life illnesses. Occupational therapists are unique professionals who can improve quality of life and well-being for the Hospice population.³ However, evidence to support the value of occupational therapy (OT) in hospice care is limited or not well documented.

DESIGN: Retrospective secondary analyses of the National Home and Hospice Care Survey (NHHCS) of 2007, the latest de-identified data in a series of the NHHCS surveys. The NHHCS is a national survey conducted by the Centers for Disease Control and Prevention.⁴ Using a stratified two-stage probability sampling design, the NHHCS collected the data from a representative sample of home and healthcare agencies and their patients receiving hospice care.

METHODOLOGY: We descriptively examined differences of demographics, health conditions, outcomes, used services, and diagnosis information between patients receiving and not receiving OT services in the context of hospice care. We used independent t-tests or Wilcoxon rank-sum test based on the normality distributions for continuous variables and Chi square tests for categorical variables. We also compared rates of frequency in admission primary, current primary and secondary diagnoses for patients receiving OT versus those that did not.

RESULTS: This study included 4,676 individuals receiving home health hospice care, with 497 receiving OT services. The majority of the total sample were non-Hispanic White (77.3%), female (63.1%), married (33.7%), Medicare recipients (56.3%) and had a life expectancy greater than 6 months (81.9%). Patients receiving OT services were overall significantly older (72.4 vs. 67.8 years old) and had shorter lengths of agency stay (91.5 vs. 273.4 days) compared to patients who did not receive OT services. Among six activities of daily living (ADL) including eating, dressing, bathing, toileting, transferring and walking, most patients (87.1%) needed assistance in at least one. However, for those who needed assistance for more than four ADL tasks, only 4.13% received OT services. Additionally, abnormality of gait (ICD9 code 7812) was the most common admission and current diagnosis for patients receiving OT services. The most common secondary diagnosis was unspecified essential hypertension (ICD9 code 4019).

CONCLUSION: Our findings showed only 10.6% of the patients received OT services while utilizing hospice care but a high percent of this population require ADL assistance. While more than eighty percent of our study sample lived exceeding six months, addressing the needs to live with dignity and receive necessary care before death should be provided. Occupational therapy can provide techniques to help patients receiving hospice care live their life to the fullest by optimizing their ADL function and quality of life, even at the end-of-life stage. OT provides benefits to the patients receiving hospice and it is imperative to advocate the role of OT in this growing population.

IMPACT STATEMENT: It is important to raise awareness of the value that OT practitioners can provide in hospice care and increase numbers of OT working in this field. This study provides valuable information and calls for further research and clinical efforts to identify and promote OT’s role in hospice care.

References

1. National Hospice and Palliative Care Organization. (2018). Facts and figures: Hospice care in America [PDF file]. Retrieved from https://www.nhpco.org/sites/default/files/public/Statistics_Research/2017_Facts_Figures.pdf

2. Etkind, S. N., Bone, A. E., Gomes, B., Lovell, N., Evans, C. J., Higginson, I. J., & Murtagh, F. M. (2017). How many people will need palliative care in 2040? Past trends, future projections, and implications for services. BMC Medicine, 15(102), 1-10. doi: 10.1186/s12916-017-0860-2

3. Hsin-Hsiu Yeh, H. H. & McColl, M. A. (2019). A model for occupation-based palliative care. Occupational Therapy in Health Care, 1-16. doi: 10.1080/07380577.2018.1544428

4. United States Department of Health and Human Services. Centers for Disease Control and Prevention. National Center for Health Statistics. (2010). National Home and Hospice Care Survey, 2007. [Data file]. Retrieved from https://www.icpsr.umich.edu/icpsrweb/NACDA/studies/28961