by editor | Mar 6, 2026 | Blog, Hospice Research Articles, Keys to Compassionate Care
What the study examined
A new national study examined US Medicare fee-for-service beneficiaries over age 65 who were admitted to an ICU between 2011 and 2023. The authors found that discharges to hospice after ICU admission increased substantially over time, including an increase in hospice discharges per 100,000 beneficiaries and a rise in the proportion of ICU patients discharged to hospice. Notably, these changes occurred while in-hospital mortality and 30-day mortality remained stable, suggesting the trend is not simply explained by sicker hospitalized patients.
What else changed over time
The study also adds important context for hospice and palliative care teams working with hospitals. Over the same period, documented DNR orders and claims for palliative care delivery increased, while median hospital length of stay remained relatively stable. The authors note that the COVID-19 years were associated with temporary increases in mortality and other measures, but without a parallel rise in discharge to hospice, followed by a return toward pre-COVID trend trajectories. At the hospital level, the analysis suggests a growing share of short-term decedents were transitioned to hospice prior to death but variation across hospitals persists.
Questions hospice clinicians and leaders can ask next
For hospice professionals, the most useful question may be what we should measure next. If hospice discharge is increasing, how do we evaluate whether the transition was timely, informed, and truly goal-concordant? What does a high-quality ICU-to-hospice transition look like in your community? How should we track outcomes after enrollment such as symptom burden, caregiver experience, and avoided unwanted interventions? Where might variation reflect thoughtful local practice, and where might it reflect inequities in access, communication, or referral pathways that we can actively improve?
References and further reading
- 2011 to 2023 Saw Rise in Discharges to Hospice after ICU Admission
- Teno JM, et al. Site of Death, Place of Care, and Health Care Transitions Among US Medicare Beneficiaries, 2000-2015 (JAMA, 2018)
- Davidson JE, et al. Guidelines for Family-Centered Care in the Neonatal, Pediatric, and Adult ICU (Crit Care Med, 2017)
- Hua M, et al. Association between the availability of hospital-based palliative care and treatment intensity for critically ill patients (Ann Am Thorac Soc, 2018)
by editor | Feb 26, 2026 | Hospice Research Articles, Keys to Compassionate Care
A recent narrative review published in Cureus examined trends in U.S. academic publications on Medical Aid in Dying (MAiD). Rather than arguing for or against MAiD, the authors analyzed the scholarly literature itself. They reviewed recent peer-reviewed articles and categorized them by position (supportive, critical, or neutral), author affiliation, specialty, and publication trends over time. One notable finding was the distribution between supportive and critical perspectives, as well as an observed increase in publications expressing concerns about MAiD in more recent years.
The paper provides a snapshot of who is contributing to the academic debate and how that debate is evolving within medical and ethical literature.
For hospice clinical staff, directors, and operators, this raises important questions. How does the academic conversation influence bedside care, team discussions, and policy development? Are hospice teams prepared to navigate questions about MAiD from patients and families, regardless of personal or organizational stance? How should leaders ensure that staff education reflects a balanced understanding of the broader ethical and clinical discourse? And as scholarly perspectives shift over time, how might that shape public perception, referral patterns, or regulatory scrutiny?
Whether one agrees or disagrees with MAiD, understanding how it is being discussed in academic medicine is valuable. The literature does not just reflect the debate – it often shapes it.
Link to Full Article
Medical Aid in Dying: A Narrative Review of the Recent Academic Literature in the United States
by editor | Jan 19, 2026 | Care Keys - Nurses, Hospice Research Articles, Keys to Compassionate Care, Patient Care
A recent study published in PLOS ONE explores how music influences the way the brain processes, learns, and remembers information. The researchers found that listening to music – especially music that is familiar and predictable – can significantly affect attention, memory encoding, and cognitive sequencing. In contrast, unfamiliar or irregular music required greater mental effort and altered how information was processed. These findings highlight that music is not simply a background experience. Rather, it is an active stimulus that shapes how the brain functions.
While the study focuses on cognitive mechanisms rather than clinical care, it adds to a growing body of evidence demonstrating music’s powerful impact on the human brain. Music engages multiple neural systems simultaneously, influencing emotion, memory, attention, and perception. This helps explain why music can be grounding, comforting, and emotionally meaningful – particularly during times of stress, illness, or transition.
Implications for Hospice Clinical Teams
For hospice clinical teams, this research reinforces what is often observed at the bedside: music can play a meaningful therapeutic role at the end of life. Music therapy in hospice is not about performance or entertainment; it is about comfort, emotional expression, symptom management, and connection. Familiar music may help reduce anxiety, support orientation, evoke memories, and create moments of calm or shared meaning for patients and families. Understanding how music affects the brain can help clinicians appreciate why patients may respond so strongly to certain songs or musical styles.
This research also invites reflection on how music is incorporated into interdisciplinary hospice care. Thoughtful use of music – whether through formal music therapy services or mindful integration into patient routines – can support holistic, person-centered care. As hospice teams continue to focus on quality of life, music offers a non-pharmacologic, deeply human tool that aligns with the goals of comfort, dignity, and presence.
Questions for the Hospice Clinical Team to Consider
As hospice care continues to emphasize whole-person, interdisciplinary, and evidence-informed practice, this research invites clinicians to pause and reflect on how music is experienced and used within patient care. Music often emerges naturally in hospice settings – through personal playlists, family memories, cultural traditions, or the work of music therapists.
Thoughtfully considering these moments can help teams better understand how music supports comfort, emotional expression, cognitive engagement, and connection at the end of life. The following questions are offered to encourage reflection, discussion, and collaboration across disciplines. The goal is to enhance patient- and family-centered care.
- How do we currently assess a patient’s relationship with music and musical preferences?
- In what ways might familiar music support comfort, emotional expression, or symptom relief for our patients?
- How can interdisciplinary teams collaborate more intentionally with music therapists?
- Are there opportunities to better educate families about the therapeutic role of music at the end of life?
Additional Reading Material
by editor | Dec 7, 2025 | Hospice Research Articles, Keys to Compassionate Care
This large-scale study analyzed 4,216 diffusion MRI brain scans from individuals aged 0 to 90. The aim of the study was to map how the brain’s structural wiring – the connections that allow different regions to communicate – changes throughout the entire human lifespan. The researchers examined how efficiently the brain moves information, how much it divides into specialized subsystems, and how central or influential key regions are.
The study discovered that brain development does not unfold as a simple rise and fall. Instead, it moves through five distinct stages, each beginning at a major turning point around ages 9, 32, 66, and 83.
- From birth to age 9, the brain is rapidly reshaping and refining its connections as it builds the foundations for childhood thinking and learning.
- Between ages 9 and 32, the brain becomes more organized and coordinated, supporting the enormous growth in reasoning, emotional maturity, and independence that occurs during adolescence and early adulthood.
- From 32 to 66, changes happen more gradually as the brain settles into a long period of relative stability in structure and function.
- Between 66 and 83, the brain begins to show clearer signs of aging, with some abilities staying strong while others weaken, reflecting the uneven changes many people experience in later life.
- After age 83, the usual patterns become much less reliable. The brain’s aging process becomes highly individual, explaining why people in their late 80s and 90s often differ greatly from one another in memory, clarity, and daily functioning.
What does this mean for hospice teams?
For hospice teams, the study’s finding that the brain becomes far less predictable after age 83 may resonate deeply with clinical experience. The clinical team likely sees patients of the same age who differ markedly in cognition, awareness, engagement, emotional responsiveness, and pace of decline. This research suggests that such variability is not unusual; it is biologically expected in the final stage of life. Recognizing this invites the question:
- How might care shift if we assume that each patient’s brain is aging in its own one-of-a-kind way rather than following a standard pattern?
And because families often struggle to understand sudden changes or fluctuating cognition, it also prompts us to ask:
- In what ways can this knowledge be used to help families reframe late-life changes not as surprising inconsistencies, but as natural expressions of highly individualized brain aging?
Seeing late-life neurobiology through this lens may guide teams toward even greater patience, flexibility, and attunement.
The study also shows that from roughly ages 66 to 83, the brain becomes more modular. What this means is that certain abilities may remain strong while others weaken. For patients in hospice care (or even as people age), you often see individuals who can still pray, sing, joke, or recall childhood memories even as problem-solving, attention, or short-term memory decline. This pattern encourages us to consider:
- How can we better identify and amplify these preserved abilities to support connection, dignity, and emotional well-being?
At the same time, many family caregivers – especially adult children – are themselves navigating demanding life stages that affect their own cognitive and emotional bandwidth. Understanding the brain’s lifelong shifts raises another reflection:
- Could recognizing the developmental pressures on caregivers help us extend more empathy and support when they appear overwhelmed, conflicted, or emotionally stretched thin?
In appreciating the parallel journeys of patients and families, the team becomes better positioned to offer care that honors the full human context of end-of-life experiences.
References
- Link to full downloadable article
by editor | Nov 19, 2025 | Hospice Research Articles
Abstract
Importance Evidence is limited regarding whether end-of-life care for individuals with dementia varies by race and ethnicity, and whether observed variations can be explained by differences in the physicians providing their care.
Objective To evaluate end-of-life care among individuals with dementia across racial and ethnic groups, and to investigate whether care variations are explained by differences in treating physicians.
Design, Setting, and Participants This cohort study used national, population-based claims data from a 20% random sample of Medicare fee-for-service beneficiaries aged 66 years or older with a diagnosis of dementia who died between 2016 and 2019. Data were analyzed from January 2024 to June 2025.
Main Outcomes and Measures Emergency department, hospital, and intensive care unit use, mechanical ventilation or cardiopulmonary resuscitation, and feeding tube placement in last 30 days of life; death in acute care hospital; hospice use and palliative care counseling in last 180 days of life; and any billed advance care planning before death.
Results Among 259 945 decedents with dementia (mean [SD] age, 85.8 [8.0] years; 60.4% female), 8.3% were non-Hispanic Black, 4.4% were Hispanic, and 87.3% were non-Hispanic White. Compared with non-Hispanic White decedents, non-Hispanic Black decedents were more likely to receive emergency department (difference, 5.7 percentage points [pp]; 95% CI, 5.0-6.4 pp), hospital (difference, 4.0 pp; 95% CI, 3.3-4.7 pp), intensive care unit (difference, 4.3 pp; 95% CI, 3.7-4.9 pp), mechanical ventilation or cardiopulmonary resuscitation (difference, 3.8 pp; 95% CI, 3.3-4.3 pp), and feeding tube placement (difference, 1.8 pp; 95% CI, 1.5-2.1 pp) care, as well as die in a hospital (difference, 3.5 pp; 95% CI, 2.9-4.1 pp). Non-Hispanic Black decedents were less likely to use hospice (difference, −6.1 pp; 95% CI, −6.8 to −5.4 pp) and more likely to receive palliative care counseling (difference, 3.2 pp; 95% CI, 2.6-3.9 pp) and billed advance care planning (difference, 1.8 pp; 95% CI, 1.2-2.3 pp) than non-Hispanic White decedents. Similar patterns were observed among Hispanic decedents. Variations in end-of-life care remained qualitatively unchanged when comparing decedents treated by the same physician.
Conclusions and Relevance Findings from this cohort study suggest that non-Hispanic Black and Hispanic decedents with dementia received more intensive end-of-life care despite higher rates of billed advance care planning and palliative care counseling than non-Hispanic White decedents. Observed racial and ethnic variations were not explained by differences in the physicians treating them.
Discussion
This study looked at how older adults with dementia in traditional Medicare were cared for at the end of life, and whether patterns differed for Black, Hispanic, and White patients. Using claims data from nearly 260,000 people who died between 2016 and 2019, the authors measured things like ER visits, hospitalizations, ICU stays, feeding tubes, CPR/ventilation, death in the hospital, hospice use, palliative care consultations, and billed advance care planning. They found that Black and Hispanic decedents with dementia were more likely than White patients to receive intensive hospital-based care in the last 30 days of life and to die in the hospital, and they were less likely to use hospice in the last six months of life. At the same time, Black and Hispanic patients were actually more likely to have billed advance care planning and palliative care counseling documented.
To understand whether “which doctor you see” explains these differences, the researchers compared patients who were cared for by the same primary care physician. The racial and ethnic gaps in intensive end-of-life care and hospice use mostly stayed the same, meaning physician practice style only explained a small part of the disparity. Over the four-year period, differences in the rates of billed advance care planning and palliative care counseling between White and Black/Hispanic patients grew, but disparities in intensive hospital use did not meaningfully shrink.
The authors conclude that structural and social factors such as access to services, timing of dementia diagnosis, cultural values, past experiences with the health system, and systemic inequities are likely driving these patterns, rather than just individual doctors’ preferences or skills.
For hospice teams, this article is a clear reminder that many Black and Hispanic people living with dementia still reach the end of life in the hospital, even when conversations about goals of care and palliative care are happening.
Practical questions to bring back to your agency include: Are we seeing disparities in our own hospice enrollment and lengths of stay for patients with dementia by race or ethnicity? How early are we connecting with families of Black and Hispanic patients before the crisis ED visit, or only once they are already hospitalized? Do our educational materials, community outreach, and marketing speak directly – and respectfully – to diverse communities’ concerns about “giving up,” spiritual beliefs, and mistrust of the system? Are we partnering with hospitalists, ED teams, nursing homes, and primary care practices that care for large numbers of Black and Hispanic dementia patients so that when palliative and advance care planning conversations occur, hospice is presented as a real, trusted option and not an afterthought?
These are the kinds of concrete, agency-level questions this paper invites hospice nurses, administrators, and marketers to wrestle with.
Link to Full Article
Link to article: End of Life Care for Older Adults with Dementia
by editor | Nov 9, 2025 | Blog, Care Keys - Nurses, Internal Marketing, Keys to Compassionate Care, Resources and Readings, Resources and Readings
Despite the clear benefits of hospice care, many patients are referred very late – sometimes in their final days of life – limiting the opportunity to benefit from its full scope. Two of the most commonly cited reasons for this delayed referral are:
- Clinician-related delays: Research shows that physicians often struggle with prognostication, lack of training in hospice eligibility and goals-of-care conversations, and uncertainty about when to refer. For example, a study found that physicians had difficulty determining prognosis and eligibility, which directly contributed to delayed hospice referral.
- Patient/family preference for curative treatment or denial of serious illness: Many families view hospice as “giving up,” and patients may seek more aggressive or curative treatments until very late. One review noted that among patients who delayed hospice, factors included desire to exhaust all treatment options and misunderstanding of hospice’s role.
Together, these barriers contribute to the pattern of late admission to hospice, which can undermine many of the benefits that hospice care is designed to provide.
Hospice care plays an essential role in ensuring patients with serious illness receive appropriate, coordinated, and compassionate care near the end of life. Yet, despite its well-documented benefits, hospice care is often initiated too late to deliver its full value to patients, families, and the healthcare system.
The Impact of Hospice Care on Outcomes and Cost
A 2023 analysis conducted by an independent research organization examined Medicare data to evaluate the impact of hospice care on outcomes and costs. The findings provide a clear picture of why timely hospice enrollment matters.
Patients who enrolled in hospice experienced lower rates of hospitalization, fewer emergency department visits, and reduced use of intensive medical interventions in the final months of life. These patients also reported higher satisfaction with care and better symptom management. Family members experienced fewer adverse emotional and financial effects during and after the end-of-life period.
From a systems perspective, hospice care was associated with significant cost savings. The study found that Medicare spending in the last year of life was approximately 3% lower for patients who used hospice than for those who did not. For patients enrolled for longer periods – particularly six months or longer – total costs were reduced by as much as 11%. The analysis also showed that after approximately 11 days of hospice enrollment, cost savings began to outweigh the costs of care, emphasizing the importance of timely referral.
These findings reinforce a central principle of hospice care: early involvement leads to better outcomes. Short hospice stays, often measured in days rather than weeks or months, limit the ability of interdisciplinary care teams to manage symptoms, provide counseling, and effectively coordinate family support. Early referral allows the full hospice model – which integrates medical, emotional, and spiritual care – to operate as intended.
Bringing the Findings Into Practice
For healthcare providers, this evidence highlights the need to normalize early discussions about hospice eligibility. For families, it underscores the importance of understanding that hospice is not a signal of giving up but a shift toward comfort, coordination, and quality of life. For policymakers and payers, it demonstrates that strengthening the hospice care model can deliver measurable value across the healthcare continuum.
Hospice care remains one of the few interventions that simultaneously improves outcomes, supports families, and reduces overall healthcare spending. Ensuring that patients are referred early enough to experience those benefits should be a shared goal for clinicians, organizations, and communities alike.
References
