AARP Hearing Center
More older Americans on Medicare are spending their final days receiving care at home or in a community setting such as an assisted living facility — not in a hospital — according to a report published last week in the Journal of the American Medical Association (JAMA). This comes as good news for experts who have defined a "good death" as one outside an intensive care unit (ICU) and free from avoidable distress and suffering for patients, families and caregivers.
The study looked into 1,361,870 Medicare fee-for-service patients and 871,845 Medicare Advantage enrollees who died between 2000 and 2015 to better understand the level and quality of end-of-life care. What they found was that after an uptick in hospitalizations between 2000 and 2009, the numbers of ICU stays and “burdensome transitions” — a term that describes any time someone dies within three days of a hospital stay — began to stabilize and improve.
“I’ve always felt that site of death only tells you where someone was in the last minutes of their lives,” says the study's lead author, Joan Teno, M.D., a professor of medicine at Oregon Health & Science University. “But what’s really important is to note the places of care … prior to that dying episode.”
The findings show that Medicare-insured patients who died in acute care settings decreased from a high of 32.6 percent in 2000 to 19.8 percent in 2015, and “people were less likely to die three days after a hospitalization or another health care transition,” Teno says. “We also saw a very striking decrease in people who had three or more hospitalizations during the last 90 days of life. That went down from 11.5 percent in 2009 to 7.1 percent in 2015.”
More on health
6 Funeral Trends That Are Changing Death Rituals
A few interesting options worth investigating