Home-Based Medical Care Is Closing the Hospice Gap: What Home Health Teams Should Know

Home-based medical care, meaning ongoing medical care in the patient's home led by physicians or advanced practice providers, is getting fresh attention for a reason home health teams will recognize. A study in Health Affairs Scholar, "Closing the Hospice Gap: The Value of Home-Based Medical Care," followed 585,226 Medicare fee-for-service decedents from 2019 and found that 70.8% of home-based medical care users enrolled in hospice, compared with 59.7% of nonusers. McKnight's Long-Term Care News covered the findings on Oct. 16, and McKnight's Home Care flagged the study in its Oct. 19 briefs.

What the study found about home-based medical care and hospice timing

Enrollment was only part of the story. Among patients who did enroll, those receiving home-based medical care had fewer ultra-short hospice stays of less than three days and fewer prolonged stays of more than 180 days. The results held whether or not patients had dementia, which matters because hospice use has shifted toward people with dementia, a group that often sees either very abbreviated stays or stays long enough to risk a live discharge. The average hospice stay nationwide is about 17 days, according to McKnight's. Yet only 13.4% of eligible Medicare beneficiaries received home-based medical care in their last years of life, and nearly two-thirds of that use happened in congregate settings such as assisted living.

Why home health agencies should pay attention

Home health clinicians are often the people in the home most regularly when a patient's condition starts to change. When that patient also has a home-based primary care or house-call provider, the study suggests the relationship can help families reach hospice conversations at a better time, not in the last few days. For agencies, the practical question is whether your team knows which patients have a home-based medical provider, and whether what clinicians see on skilled visits actually reaches that provider before the next crisis. A short, consistent handoff that says who to call, what changed and what was observed on recent visits usually does more than a long note nobody reads.

A few steps are worth building in now. Note which referral sources and current patients are connected to home-based primary care or house-call practices. Agree on what counts as a change worth flagging, such as declining function, repeated emergency visits, or a family starting to ask new questions about goals of care. Watch whether planned visits are still happening as a patient declines, since changes in the visit pattern can be an early sign that needs have shifted. CareSync® helps here by keeping scheduled and completed visits side by side, so the team can see what was planned and what was delivered when a plan of care starts to change.

The study is observational and uses 2019 data, so it shows an association rather than proof that home-based medical care causes better hospice timing. Still, it adds to the evidence that coordinated care in the home helps seriously ill patients get the right support at the right time, and home health agencies are well placed to be part of that coordination.