Closing the Hospice Gap: The Value of Home-Based Medical Care

Abstract Introduction Home-based medical care (HBMC), longitudinal medical care provided in a patient’s home led by physicians or advanced practice providers, addresses complex medical and social needs of seriously ill older adults, particularly those with dementia. We examined whether HBMC use is associated with hospice enrollment and length of stay and whether this varies by dementia status. Methods We analyzed data from 100% fee-for-service Medicare decedents in 2019, who were eligible for HBMC prior to death. Models used inverse probability weighting, adjusting for clinical, demographic, and regional characteristics. Results HBMC users had greater odds of hospice use (OR=1.34; 95% CI= 1.33-1.35) compared to non-users, regardless of dementia status. For hospice enrollees, HBMC use minimized both ultra-short (<3 days) and prolonged (>180 days) stays, with a stronger reduction in short stays for dementia patients. Conclusion As more older adults age in the community and hospice services expand to support patients with complex illnesses like dementia, HBMC may offer a valuable strategy for effectively navigating prognosis uncertainty and the complexities of hospice eligibility requirements and enrollment.