Stroke Patients: Hospice Stay Duration And Care

Stroke patients may require hospice care if they are facing severe symptoms such as difficulty speaking and moving, persistent vegetative state or coma, disorientation, and difficulty chewing and swallowing, among others. Hospice care provides comfort and support to stroke patients and their families by managing symptoms and pain. While there is no one-size-fits-all answer to how long stroke patients stay in hospice care, it is important to consider the specific needs and conditions of each patient. Hospice care can be provided in the patient's home or in a dedicated facility, depending on the situation. The length of stay in hospice care depends on various factors, including the patient's prognosis, the severity of their stroke, their overall health condition, and their response to treatment.

Hospice criteria for stroke patients

Stroke is the fifth leading cause of death and a leading cause of disability in the United States. It occurs when a blood vessel carrying oxygen and nutrients to the brain is blocked by a clot or ruptures. As a result, brain cells are deprived of oxygen and begin to die, leading to a loss of abilities controlled by the affected part of the brain, such as memory and muscle control.

Hospice care is often considered for patients in the terminal stages of a stroke. The criteria for hospice eligibility for stroke patients include:

• A prognosis of six months or less to live if the disease runs its normal course, as determined by a hospice physician in collaboration with the attending physician.
• Poor functional status, requiring assistance with activities of daily living (ADLs) such as feeding, transferring, ambulation, bathing, continence, and dressing.
• Impaired functional status, including changes in orientation status and requiring assistance with remembering daily tasks or routines.
• Inability to maintain sufficient fluid and caloric intake, leading to progressive weight loss.
• Comorbidities or rapid functional decline.
• A Palliative Performance Score or Karnofsky score of 40% or less from a primary care physician.
• Bed or wheelchair-bound.
• Coma or vegetative state.

It is important to note that hospice care is not only for cancer patients but is also beneficial for stroke patients and their families, providing comfort, support, and management of symptoms and pain.

Signs it may be time to set up hospice care

Hospice care is an option for those seeking to improve their quality of life by reducing the symptoms, side effects, and anxiety of a severe illness. It is important to know that anyone can refer someone for hospice care. Here are some signs that it may be time to set up hospice care:

Progressive Weight Loss

If your loved one is experiencing sudden or progressive weight loss, it may be time to consider hospice care. This could be a sign of eating difficulties, loss of appetite, or other health issues.

Difficulty Performing Daily Tasks

If your loved one is having difficulty performing daily living tasks, such as bathing, getting out of bed, getting dressed, walking, or preparing and eating meals, it may be time to consider hospice care. This is especially true if they require assistance with these activities.

Frequent Hospitalizations or Trips to the ER

If your loved one is making frequent visits to the emergency room or is hospitalized often, it may be a sign that they need the specialized care that hospice can provide.

Inability of Familial and Medical Teams to Provide Adequate Care

If you and your family are struggling to provide the necessary care for your loved one, it may be time to consider hospice care. Hospice professionals can provide the expertise and support needed to ensure your loved one's needs are met.

Mental and Physical Changes

Mental and physical changes, such as decreasing alertness, withdrawal, increased sleeping, mental confusion, or a decrease in desire to eat, can be signs that hospice care may be beneficial. These changes can indicate a decline in health and the need for specialized support.

It is important to remember that hospice care is about providing comfort and improving the quality of life for your loved one. If you are noticing these signs, it may be time to reach out to a hospice care professional to discuss your options and determine the best course of action for your loved one's specific needs.

How long do stroke patients stay in hospice?

The length of a stroke patient's hospice stay depends on several factors, including the severity of the stroke, the patient's prognosis, and their individual needs. While there is no one-size-fits-all answer to this question, here is some information on the factors that can influence the duration of hospice care for stroke patients.

Firstly, hospice care for stroke patients is typically considered when the patient's condition is worsening and they are exhibiting severe symptoms. These symptoms can include difficulty speaking and moving, requiring extensive assistance with daily activities, being mostly bedridden, and experiencing a loss of bodily functions. The presence and severity of these symptoms can impact the length of the hospice stay.

Secondly, eligibility criteria for hospice care after a stroke usually include being mainly bed or chair-bound, having an impaired functional status, requiring assistance with activities of daily living (ADLs), and experiencing progressive weight loss and nutritional deficiencies. The patient's prognosis is also a critical factor, with a prognosis of six months or less to live being a common criterion for hospice eligibility. The patient's nutritional status, such as their ability to maintain sufficient fluid and caloric intake, also plays a role in determining hospice eligibility and the duration of care.

In addition, the patient's overall health condition and the specific complications they are experiencing after the stroke can influence the length of their hospice stay. For example, recurrent infections, urinary tract infections, pressure ulcers, and fever can be factors in determining the need for hospice care and the duration of that care.

It's important to note that hospice care for stroke patients aims to provide comfort and manage the patient's symptoms and pain. This can include visits from hospice nurses, aides, social workers, and counsellors, as well as medication and medical equipment to treat stroke-related symptoms. The patient's response to this care and their overall health trajectory can also impact the length of their hospice stay.

While there is no definitive answer to the question of how long stroke patients stay in hospice, it is clear that the decision to utilise hospice care for stroke patients should be made in consultation with healthcare professionals, who can provide specific insights into the patient's condition, prognosis, and individual needs.

Predictors of hospice utilisation

Hospice is considered an underutilised service, especially among patients with non-cancer diagnoses such as stroke. However, a study by duPreez et al. (2008) found that hospice enrolment rates among patients who die within the first 30 days of their stroke are much higher than previously thought. The study identified several sociodemographic and clinical predictors of hospice utilisation:

• Older age: Each successive age group had a higher unadjusted rate of enrolment, ranging from 10% to 28%.
• Female gender: Females had a higher enrolment rate of 25% compared to 20% for males.
• Health management organisation (HMO) membership: An enrolment rate of 26% was observed among HMO members, compared to 23% for patients with traditional fee-for-service plans.
• Length of hospital stay: An index hospital stay of more than 3 days was associated with an increased likelihood of hospice enrolment.
• Race: African Americans had lower enrolment rates (12%) compared to Caucasians and other minorities (25%).
• Mechanical ventilation: Patients who received mechanical ventilation had significantly lower utilisation of hospice.
• Gastrostomy tube placement: Patients who received artificial nutrition through a gastrostomy tube were less likely to enrol in hospice.
• Comorbidities: Uncomplicated diabetes mellitus and valvular disease were associated with decreased hospice enrolment, while dementia predicted an increased rate.

When in-hospital deaths were excluded from the analysis, overall hospice enrolment increased to 44%. In this subgroup, advancing age, HMO membership, and dementia were no longer predictors of increased hospice enrolment. Additionally, a length of stay longer than 3 days predicted decreased enrolment.

Eligibility for hospice care

Prognosis and Terminal Stage

To be eligible for hospice care, patients must have a prognosis of six months or less to live if the disease follows its normal course. This determination is made by a hospice physician in collaboration with the attending physician. This prognosis indicates that the patient is in the terminal stage of a stroke.

Functional Status

One of the critical indicators for hospice eligibility is the patient's functional status. Patients who are mainly bedridden or wheelchair-bound and require maximal assistance with activities of daily living (ADLs) are considered to have a poor functional status. This includes needing help with self-care tasks, such as bathing, dressing, and eating.

Nutritional Status

Another important factor is the patient's nutritional status. Eligibility criteria include a normal or reduced food and fluid intake, inability to maintain adequate hydration and caloric intake, and progressive weight loss. This may be due to difficulties swallowing (dysphagia), loss of appetite, or other health issues.

Medical Complications

Documentation of medical complications within the previous 12 months, indicating a progressive clinical decline, supports eligibility for hospice care. These complications can include recurrent infections, urinary tract infections, stage 3-4 decubitus ulcers, and fever recurrent after antibiotics.

Changes in Orientation Status

Disorientation or changes in mental status, such as confusion or difficulty with memory, are also considered in determining eligibility for hospice care.

Palliative Performance Score

A Palliative Performance Score or Karnofsky Score of 40% or less is a significant indicator used by physicians to assess eligibility for hospice care. This score takes into account the patient's functional status, nutritional status, and overall condition.

It is important to note that even if a patient does not meet all the criteria, they may still be eligible for hospice care due to comorbidities or rapid functional decline. The decision to elect hospice care should be made in consultation with healthcare professionals, who can provide guidance and support in determining the most appropriate care plan for the patient.

Frequently asked questions