National Trends in Types of Hospice Disenrollment Among Older Adults With Dementia, 2012–2019
{"BACKGROUND:":[0],"Older":[1],"adults":[2,30,54,149,247],"with":[3,31,55,95,150,192,226,248],"dementia":[4,32,56,96,151,249],"in":[5,48,68,129,152,164,172,230],"hospice":[6,26,49,61,91,104,243],"have":[7],"a":[8,17,19],"higher":[9,220],"risk":[10],"of":[11,88,119,280],"disenrollment":[12,27,105,155,222,244,253,282,291],"(\\"live":[13],"discharge\\"),":[14],"which":[15],"is":[16],"often":[18],"disruptive":[20],"care":[21],"transition":[22],"for":[23,122,242],"patients.":[24],"High":[25],"among":[28,52,245,272],"older":[29,53,148,246],"has":[33],"drawn":[34],"federal":[35,65,142,197,260],"scrutiny":[36],"related":[37],"to":[38,114,166,176,186,238,255],"Medicare":[39,73,90],"Hospice":[40,81],"Benefit":[41],"integrity":[42],"concerns.":[43],"We":[44,126],"examined":[45],"national":[46],"trends":[47],"disenrollment,":[50],"2012-2019,":[51],"by":[57,108,283],"agency-reported":[58,109,240,290],"reason":[59,110],"and":[60,79,107,124,132,135,140,201,233,269],"ownership,":[62],"considering":[63],"two":[64],"policies":[66],"implemented":[67],"that":[69],"period:":[70],"2014":[71],"Improving":[72],"Post-Acute":[74],"Care":[75],"Transformation":[76],"(IMPACT)":[77],"Act":[78],"2016":[80],"Payment":[82],"Reform.":[83],"METHODS:":[84],"Serial":[85],"cross-sectional":[86],"study":[87,210],"all":[89,193],"enrollees":[92],"65+":[93],"admitted":[94],"as":[97],"their":[98],"qualifying":[99],"terminal":[100],"illness.":[101],"Outcomes":[102],"included":[103],"overall":[106,154,221,263],"(extended":[111],"prognosis,":[112],"transfer":[113],"another":[115],"hospice,":[116,153],"moves":[117,202,214,270],"out":[118],"service":[120],"area,":[121],"cause,":[123],"revocation).":[125],"estimated":[127],"intercepts":[128],"September":[130],"2012":[131,165,237],"December":[133],"2019":[134],"monthly":[136],"percentage":[137],"change":[138],"before":[139],"after":[141,196,259],"policy":[143,198,261],"implementation.":[144,199],"RESULTS:":[145],"Among":[146],"1,436,018":[147],"decreased":[156,179],"slightly":[157,205,227],"from":[158,180],"24.0%":[159],"(95%":[160,168,182,188],"CI:":[161,169,183,189],"23.6%,":[162],"24.4%)":[163],"23.2%":[167],"22.8%,":[170],"23.6%)":[171],"2019.":[173],"Disenrollment":[174],"due":[175,254],"extended":[177,256],"prognosis":[178,257],"10.9%":[181],"10.7%,":[184],"11.2%)":[185],"9.7%":[187],"9.3%,":[190],"9.8%),":[191],"decreases":[194],"occurring":[195],"Transfers":[200],"both":[203],"increased":[204],"but":[206],"steadily":[207],"across":[208],"the":[209,278],"period":[211],"(transfers":[212],"2.6%-4.0%;":[213],"0.7%-1.5%).":[215],"For-profit":[216],"hospices":[217],"had":[218],"consistently":[219],"rates":[223,264],"than":[224],"nonprofits,":[225],"widening":[228],"differences":[229],"transfers,":[231],"moves,":[232],"revocations.":[234],"CONCLUSIONS:":[235],"From":[236],"2019,":[239],"reasons":[241,292],"shifted":[250],"modestly.":[251],"Although":[252],"declined":[258],"implementation,":[262],"changed":[265],"little":[266],"because":[267],"transfers":[268],"increased-particularly":[271],"for-profit":[273],"hospices.":[274],"Our":[275],"findings":[276],"show":[277],"importance":[279],"disaggregating":[281],"type.":[284],"Future":[285],"research":[286],"should":[287],"examine":[288],"how":[289],"reflect":[293],"underlying":[294],"circumstances.":[295]}
Authors
- Alexandra K. Lee (ORCID: https://orcid.org/0000-0001-9525-3833)
- Krista L. Harrison (ORCID: https://orcid.org/0000-0001-5373-3011)
- Lauren J. Hunt (ORCID: https://orcid.org/0000-0002-2731-2173)
- Siqi Gan (ORCID: https://orcid.org/0009-0004-8050-570X)
- Melissa D. Aldridge (ORCID: https://orcid.org/0000-0002-3334-4542)
- Claire K. Ankuda (ORCID: https://orcid.org/0000-0003-1371-8524)
- W. John Boscardin
- Alexander K. Smith
Institutions
- University of California, San Francisco (US)
- Dartmouth Psychiatric Research Center (US)
- San Francisco VA Health Care System (US)
- Global Brain Health Institute (US)
- Northern California Institute for Research and Education (US)
- Philip R. Lee Institute for Health Policy Studies (US)
- Icahn School of Medicine at Mount Sinai (US)
Publication Details
- Journal
- Journal of the American Geriatrics Society
- Published
- 2026-09-15
- DOI
- https://doi.org/10.1111/jgs.70707
- Primary Topic
- Palliative Care and End-of-Life Issues
- Type
- article
- Field-Weighted Citation Impact
- 0.00
Funders
- National Institutes of Health
- National Institute on Aging