Hospice care of the intravenous drug user AIDS patient in a skilled nurse facility.

We report on the initial experience in hospice care for a predominantly poor, black and Hispanic intravenous drug user AIDS population in New York City. Hospice care was provided in a skilled nursing facility with a certified hospice program delivering home care and inpatient care. A formal education program preceded patient admission to familiarize the staff and institution with AIDS issues. Between February 1986 and January 1988, 62 of 175 referred patients were accepted for hospice admission. The patients' mean age was 39 years and all had AIDS dementia complex. The mean length of stay was 35 days (range 1-280 days) and a total of 2011 days of hospice care was provided. Ninety-one percent of hospice days were spent on the inpatient unit; only 9% of hospice days were provided at home. Despite the requirement of expensive inpatient hospice care for most patient days, the estimated savings in decreased costs compared to acute hospital inpatient care was $751,488 for these 62 patients. Continuing fear of transmission among hospice staff was not a major problem; however, several unanticipated problems arose including (a) inability to provide home services, (b) continued drug abuse, (c) increased staff stress, (d) difficulty maintaining confidentiality, (e) difficult interactions with funeral directors, and (f) unsupportive and inappropriate funding requirements. Hospice care of AIDS patients is feasible, humane, and cost effective but problems of the intravenous drug using population require special attention and program modifications if hospice care is to be provided for this substantial and growing AIDS population.