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Heavier patients less likely to receive hospice care at end of life

Hospital bed
(photo by Steve Carmody/Michigan Radio)
An empty hospital emergency room bed

The weight of terminally-ill patients can play a role in the type of treatment they receive toward the end of their lives.

That’s the conclusion of a new study from the University of Michigan Institute for Healthcare Policy & Innovation. The research, which compared survey results from the University of Michigan Health and Retirement Study to Medicare records for more than 5,600 people, found a strong connection between the body mass index (BMI) of the terminally ill and the likelihood that they end their lives in hospice care. 

In particular, people with higher BMI were substantially less likely to end their lives in hospice care than the rest of the population.

Dr. Jennifer Griggs is the senior author of the study. She is a professor at the University of Michigan Medical School, where she treats patients at the university's Comprehensive Cancer Center. 

Griggs said one of the reasons these results are concerning is that hospice care is one of the best ways for terminally ill patients to end their lives.

“Studies have shown that hospice care improves quality of life, it improves symptom management, such as shortness of breath, pain control,” Griggs said. “And even after the patient has died families will tell us that their quality of life, their bereavement experience is better if the patient was on hospice.”

Griggs suggested a number of possible reasons BMI would affect a patient’s acceptance to hospice care.

One is that there are practical challenges to treating heavier patients with hospice care. In some situations, a single hospice care nurse may be injured trying to move or reposition a patient in hospice care.

Another is financial.

“You need lifts to take care of people, and hospices get paid a flat fee,” Griggs said. “No matter how intense it is to take care of that patient, they don’t make more money, there’s no adjustment for that.”

That creates a disincentive for care providers to take on patients who may be more expensive to treat.

One possible solution: reimburse hospices according to the cost of care.

In the end, Griggs hopes this research will shed light on the barriers patients face to getting into hospice care. Listen to our full interview with Dr. Jennifer Griggs above.

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