Medicare’s hospice benefit covers services not only for a terminally ill beneficiary. Family caregivers also can receive grief and loss counseling for up to a year following the beneficiary’s death. However, a recent study found that hospice services had only a modest impact on symptoms of depression in surviving spouses.

The study, published online in JAMA Internal Medicine earlier this week, examined symptoms of depression among 1,016 surviving spouses who were interviewed as part of the Health and Retirement Study, an ongoing survey of a representative sample of adults older than age 50. The data was linked to Medicare claims.

More than half of the spouses experienced a worsening of their depressive symptoms following their loved one’s death, regardless of whether they used hospice, the study found.

Of the surviving spouses whose depressive symptoms improved, 28 percent were married to hospice users, while 22 percent were married to those who did not use hospice. The study could not determine how many of the spouses received bereavement benefits because that service is not billed separately from other Medicare hospice services.

As a believer in the benefits of hospice, lead author Katherine Ornstein, an epidemiologist at the Icahn School of Medicine at Mount Sinai in New York, called the modest impact of hospice on depressive symptoms of surviving spouses “disappointing.”

However, “I think it’s more of an opportunity to say hospice already has a system set up to help families, and what more can we do?”

The bereavement services that hospices offer vary. They may include support groups, memorial ceremonies and educational materials in addition to cards or telephone calls expressing sympathy and support.

An editorial accompanying the study noted that end-of-life care may itself have an antidepressant effect on surviving spouses. Hospice services can ease the caregiver’s burden and offer respite from tending to the spouse’s physical and emotional needs. In addition, “Hospices may also promote the spouse’s preparation for the patient’s impending death and may combat feelings of isolation and helplessness by providing social interaction and professional support,” write the authors, Holly G. Prigerson of Cornell University and Kelly Trevino of the Weill Cornell Medical College in New York.

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