Is a Home-Care Network Necessary to Access the Medicare Hospice Benefit?

Posted: 20 Jun 2007

See all articles by Courtney Van Houtven

Courtney Van Houtven

Duke University

Donald H. Taylor

Duke University - Center for Health Policy, Law and Management

Karen Steinhauser

Duke University - Medical Center

James A. Tulsky

Duke University Medical Center

Date Written: June 2007

Abstract

Informal care is a common source of both custodial and medical care in the home for adults who are terminally ill. Formal (paid) home health care is also common, having exploded in the past 15 years due to the rapid expansion of Medicare and Medicaid's home health care benefits. We know little about how informal and formal home care affect the use of hospice care at the end of life, beyond the common assumption that in-home hospice use is not possible without the presence of in-home support. If a home-care network is necessary to access the hospice benefit, this could indicate an unintended access barrier for a proportion of Medicare beneficiaries, those with no sources of support in the home. Similarly, if an informal care network is necessary for terminally ill nursing home residents to access the hospice benefit, it may indicate an additional unintended access barrier for some Medicare beneficiaries. We examine the home-care network of decedents in the Medicare Current Beneficiary Survey in the year of their deaths to answer three key research questions. Does the presence of an informal or formal care network in the home (or informal care network for persons who die while residing in a nursing home) lead to different hospice utilization patterns among decedents? Second, do decedents with strong home-care networks access the hospice care benefit sooner or later compared to decedents with weaker home-care networks, controlling for differences in health status and other important covariates? Finally, are there differences in access to hospice care by the relationship of the caregiver and care recipient?

Keywords: Medicare hospice benefit, informal care, home care, end-of-life

JEL Classification: I12, J12, J14

Suggested Citation

Van Houtven, Courtney and Taylor, Donald H. and Steinhauser, Karen and Tulsky, James A., Is a Home-Care Network Necessary to Access the Medicare Hospice Benefit? (June 2007). iHEA 2007 6th World Congress: Explorations in Health Economics Paper. Available at SSRN: https://ssrn.com/abstract=993885

Courtney Van Houtven (Contact Author)

Duke University ( email )

100 Fuqua Drive
Durham, NC 27708-0204
United States

Donald H. Taylor

Duke University - Center for Health Policy, Law and Management ( email )

Box 90253
Durham, NC 27708
United States
(919) 684-2361 (Phone)
(919) 684-6426 (Fax)

Karen Steinhauser

Duke University - Medical Center ( email )

100 Fuqua Drive
Durham, NC 27715
United States

James A. Tulsky

Duke University Medical Center ( email )

Durham, NC 27710
United States

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