OBJECTIVES: 1.72 million Medicare beneficiaries were enrolled in hospice care in 2020. Hospice care enrollment yields savings for payers for many categories of patient. Additionally, disenrollment in hospice has been found to result in higher Medicare expenditures. The majority of Medicare days associated with hospice care take place in the home – a challenge for IUCs as these patients typically present with numerous co-morbidities including urinary incontinence which affects 84% of hospice patients. A major reason for hospice patients’ return to the hospital setting is caregiver burden. This analysis seeks to determine the hours that IUCs provide to end-of-life patients in the community. Further, this analysis estimates the percentage of time that could be saved with a novel FEC that has been found to reduce time expended in the care of female patients with urinary incontinence.

METHODS: A systematic literature review of published research (2007-2022, PubMed and Embase databases) assessed the workload of IUCs who provided end-of-life care to primarily community-dwelling, US-based patients in the last 6 to 12 months of life. The results were modeled against research on the daily caregiver time savings afforded by use of an FEC.

RESULTS: 71 records were identified. After exclusions, 5 records were analyzed. The weekly IUC burden averaged between 22.9 and 65.8 hours. A 2022 study of caregivers (N=205) found the middle tertile reported daily time savings with an FEC of 1 to 3. The model determined that IUCs, providing end-of-life care, could expect the use of an FEC to reduce their weekly caregiver hours between 21% and 61%.

CONCLUSIONS: This analysis suggests that utilization of FECs, in appropriate hospice or end-of-life patients, may reduce the burden of IUCs who care for those patients in the community setting. Prospective studies should be considered to validate these findings including the impact of FEC utilization upon hospice disenrollment.