Large VA study finds sixfold higher hospice enrollment when palliative care is involved; mental‑health care alone was linked to lower hospice use.

Veterans living with serious mental illness (SMI)—such as schizophrenia or bipolar disorder—and heart failure were far more likely to use hospice in their last six months of life if they had earlier contact with palliative care. In a national VA analysis of 9,369 deceased Veterans with both SMI and heart failure (2011–2020), palliative care engagement was associated with roughly six times higher odds of hospice enrollment, while engagement with mental‑health services alone was associated with lower odds.  

By the numbers

• Who was studied: 232,079 Veterans who died with heart failure; 9,369 also had SMI. Veterans with SMI were less likely to enter hospice than those without SMI (36% vs. 43.8%).  
• Comparing care pathways among Veterans with SMI:
  • Neither mental‑health nor palliative care: 23.9% entered hospice (281/1,171).
  • Mental‑health care only: 17.5% entered hospice; adjusted odds ratio (aOR) 0.74 vs. neither.
  • Palliative care only: 59.5% entered hospice; aOR 5.96.
  • Both palliative and mental‑health care: 60.5% entered hospice; aOR 6.67.A bar chart on page 4 (Fig. 2) illustrates this gap—about 18–24% hospice use without palliative care versus ~60% with it.  

Why it matters

Hospice care can improve quality of life, reduce hospital visits, and support families near the end of life. Yet people with SMI face barriers to end‑of‑life services. This study suggests that palliative care teams play a pivotal role in connecting these patients to hospice when it’s appropriate.  

How the study worked

Researchers reviewed VA and Medicare records. They measured contact with mental‑health and palliative care 6–18 months before death, then looked for any hospice enrollment in the final six months. Veterans were grouped by whether they had consistent mental‑health visits (3+), a palliative‑care consult, both, or neither (see the flow chart on page 2, Fig. 1).  

What’s driving the gap?

The authors note that mental‑health services are often outpatient while palliative care is frequently inpatient, and clinicians in each specialty may have limited cross‑training—factors that can delay or deter hospice referrals. They argue that closer collaboration and cross‑training between mental‑health and palliative‑care teams could improve end‑of‑life care for people with SMI.  

Bottom line

For Veterans with serious mental illness and heart failure, palliative care is a key bridge to hospice. Health systems that encourage joint workflows between palliative‑care and mental‑health teams may help more patients and families receive timely, supportive end‑of‑life care.  

Source: Boozalis J., Perreault J., Turner H.I., et al. “A retrospective study of deceased veterans with serious mental illness and heart failure: Analysis of palliative care and mental health collaboration on hospice utilization,” General Hospital Psychiatry (2025).  

Editor’s note: This article is for information only and is not a substitute for professional medical advice.