Average Length of Stay - Multi-Pedia
Average Length of Stay (Terminated Patients) = Total patient-days for terminated patients/ Number of terminated patients.
| Measurement |
Average |
Acceptable |
Excellent |
| Average Length of Stay (Terminated) |
64 |
90 |
?? |
You want EVERY patient -- whether they live one minute or one hour -- for CAP purposes. You want Hospice Homecare Average Length of Stay (ALoS) as high as possible without exceeding CAP.
ALoS, like most measurements, has its flaws and should be looked at suspiciously. First, does the measurement number include the Inpatient Unit? This will skew overall Hospice numbers downward. (Low ALoS in the Inpatient Unit itself isn't a bad thing). Second, ALoS as most Hospices compute it, only counts terminated patients via death or discharge. Therefore, some patients will NEVER be included in the calculation! It can be a dangerous measurement to rely on and it has misguided many Hospices into millions of dollars in CAP paybacks.
A better indication that you may be close to the Aggregate CAP is to calculate the Median Los on LIVING patients...NOT terminated patients. If your Hospice is close to 170 days, you're very close to trouble. ALoS based on terminated patients is of no value here because the patients driving the CAP are not included in the calculation! Think about it.
Increase Average Length of Stay (ALoS)
Increasing ALoS obviously increases ADC as people are on the program longer. This area demands much more attention than it gets. Here are some observations:
- Deep Penetration in the Community. Here we are talking about getting referrals directly from the community. The Hospices with the highest ALoS have a disproportionate percentage of referrals from the community. How do they do it? The key is to know your communities, know what they value, and develop deep inroads with key organizations and people. Several high ALoS Hospices have the Watchman Program. What we like about the Watchman Program is that it creates a new class of volunteer and effectively can set 1,000 more sets of eyes on the community. They are trained to in what to look for and "how" to best present the Hospice option in a comfortable and friendly way. Other Hospices with a high ALoS find other ways to connect to their communities. For example, if your community has large manufacturing plants that employ thousands of workers, find ways so that every employee knows about Hospice. What do they do with their time? How could you plug into their world so that they will remember Hospice when there is a need?
- Filling in Knowledge Gaps. Recently, my mother was diagnosed with cancer of the brain. As we were talking one evening, I discovered that she did not know that Hospice could help her NOW, even though she has 6-9 months to live. Even with my work in Hospice for more than a decade, I had not done a good job at educating her on the subject. She believed that Hospice was to be called "near the end." It shocked me...and I knew that there is a ton of education work still to be done... Don't take for granted that people really understand and know about the benefits of Hospice...they don't.
- Define Your Language Regarding Length of Stay. As part of your standard outreach language, you must CONTINUALLY speak about the need for patients to get signed up sooner. Use testimonies of people that have said "if only we would have known about Hospice sooner" and similar messages... Over time and through repetition, it works. Most of the time we just don't say it enough.
- Open Access. By expanding the paradigm of what a Hospice looks like, usually ALoS will increase. Many Hospices take patients that are seeking non-traditional Hospice treatments and therapies. One result of this practice is that patients will sign up for Hospice earlier in the disease process, thus increasing length of stay (LOS). For more information, request the audio CD Open Access - An Interview with Carolyn Cassin or download the MP3 by going to the E-Normous Library and searching Open Access in the search field. Be sure to log in first!