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American Way of Death Shifts Away From Hospitals, ICUs

American Way of Death Shifts Away From Hospitals, ICUs
(Katarzyna Bialasiewicz/Dreamstime)

By    |   Wednesday, 27 June 2018 12:10 PM

The American way of death is shifting away from hospitals and intensive care units and instead is taking place in homes and other "community settings," according to a study of seniors insured by Medicare between 2000 2015, The Los Angeles Times reported.

The study was published this week in the Journal of the American Medical Association and was based on an analysis of records from 1,361,870 Medicare fee-for-service enrollees and 871,845 Medicare Advantage enrollees who died between those two years. The average age at death was 82.

Overall, the Times said, just under 20 percent of Medicare-insured patients who died in 2015 did so in an acute-care hospital, down from 32.6 percent who did so in 2000. Some 40 percent of the patients died in a home, hospice, assisted living facility or other community setting in 2015 — up from about 31 percent in 2000.

The study showed that the proportion of American seniors being admitted to an intensive care unit during their final month of life has stabilized, after rising between 2000 and 2009, according to the Times.

"Among Medicare fee-for-service beneficiaries who died in 2015 compared with 2000, there was a lower likelihood of dying in an acute care hospital, an increase and then stabilization of intensive care unit use during the last month of life, and an increase and then decline in health care transitions during the last three days of life," the study said in its conclusion.

"There was a greater collective awareness that not all medical interventions are equally beneficial, and that the potential harms of some needed to be weighed," Dr. Diane E. Meier told the Times. She is a geriatrician and palliative care specialist who directs the Center to Advance Palliative Care and was not involved in the new research,

The study said while there could be several reasons for the shift, such as better public education, promotion of advance directives through the Patient Self-Determination Act, increased access to hospice and palliative care services, financial incentives of payment policies, and other secular changes, it found it difficult to say how much those examples were making a difference.

"This study has several limitations. First, the finding that the proportion of deaths that occurred in the community increased among Medicare fee-for-service decedents should be interpreted with caution," the study stated.

"This research relied on Medicare billing data and minimum data set assessments to determine the site of death based on the place of service recorded on the submitted claims. Medicare billing data do not differentiate community deaths that are in a personal home, in an assisted living facility, or at foster care home except for decedents who died while receiving hospice services." the statement continued.

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The American way of death is shifting away from hospitals and intensive care units and instead is taking place in homes and other "community settings," according to a study of seniors insured by Medicare between 2000 2015.
american, death, shift
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2018-10-27
Wednesday, 27 June 2018 12:10 PM
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