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News
Hospice disenrollment among older adults with dementia stayed relatively stable from 2012 to 2019, but the reasons patients left shifted significantly. Federal policy reforms helped reduce "extended prognosis" discharges, yet transfers and service-area moves climbed — especially at for-profit hospices. The findings highlight how policy changes can have unintended ripple effects on end-of-life care.
Overall hospice disenrollment among older adults with dementia barely budged between 2012 and 2019 — dropping just slightly from 24.0% to 23.2%. But beneath that stable headline number, a meaningful shift was underway. Federal reforms, including the 2014 IMPACT Act and 2016 Hospice Payment Reform, helped curb discharges attributed to "extended prognosis," but those gains were partially offset by rising transfers to other hospices and moves out of service areas.
The ownership type of a hospice made a notable difference. For-profit hospices had disenrollment rates of 30.5% by December 2019, compared to just 18.3% at nonprofit facilities. Patients moved out of service areas at for-profit hospices also faced higher rates of hospitalization within 3 days (47.6% vs. 37.8% at nonprofits) — a signal of potential care disruption at a critical time.
Why it matters: For the 1.4 million+ Medicare beneficiaries with dementia navigating hospice, why they leave matters as much as whether they leave. Policy reforms are working — but gaps between for-profit and nonprofit hospices suggest more targeted oversight may be needed to protect vulnerable patients at end of life.
