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De-Coding Changes in End-of-Life Care

Nursing home abuse and neglect lawyers at Pintas & Mullins highlight a recently published study outlining the changes in end-of-life-care for Medicare beneficiaries. The findings illuminate issues surrounding sites of passing, places of care, and the health care transitions that our nation’s seniors made in their final days.

The article, published in the Journal of the American Medical Association, described these changes as they occurred between 2000, 2005, and 2009. The patients examined in the study were aged 66 years and older, and were classified as diagnosed with pulmonary disease, dementia, or cancer, in the last 180 days of their lives. In total, nearly 850,000 patients were evaluated.

There was a significant increase in the percentage of seniors dying at home, from 15% in 1989 to 24% in 2007. Other changes in the “site of death” percentages included 7% more passing away in nursing homes and 14% less passing in acute care hospitals. The use of hospices and palliative care services also expanded, which may prove that these systems are successfully aiding our nation’s seniors at the end of their lives.

Hospice care systems are designed to provide coordinated, team-based, patient-centered comfort care to those with terminal illnesses. When functioning at their peak these systems reduce unnecessary hospitalizations, therefore saving healthcare dollars. Between 2007 and 2011, the number of patients receiving hospice care increased by 16%, to 1.65 million Americans. Hospice systems are a $14 billion dollar business, and Medicare is billed for about 84% of the services. Traditionally, hospice care was reserved primarily for cancer patients, although in recent years, more and more enrolled patients have illnesses such as heart disease and dementia.

The use of hospice services at the time of death increased steadily throughout the years studied. In 2000, the rate was about 22%, in 2005, it was 33%, and in 2009 the rate was at nearly 43%. This indicates that the hospice system is doing something right, as more and more patients are asking to be enrolled and spending their last days there. However, nearly 30% of those patients were only enrolled in hospice for three days or less before passing.

This late-stage enrollment points to an important issue, perpetuated by the fact that patients were more likely to be hospitalized in the final three months of their lives, and were more likely to spend time in the ICU. Additionally, transitions between healthcare institutions in the last 90 days of life increased 50% between 2000 and 2009, from an average of two to an average of three, and 14% were forced to transition in their last three days. More than 11% were hospitalized three or more times in their last 90 days, and, most disturbingly, patients with dementia spent considerably more time in the ICU in 2009.

So, what do these figures mean? They confirm that American seniors are not given patient-based comfort care until their illnesses are extremely advanced. The majority stay in nursing homes for years, with minimum care, and are subjected to numerous transfers between healthcare facilities in their last days. Nursing home residents often suffer from chronic illnesses, and death is usually able to be projected. So why are 30% of seniors not enrolled until their final three days? Many more studies need to be conducted to find the answer.

Palliative care systems, like hospice care, provide multidisciplinary, integrated care that reduces patient pain and meets their social and spiritual needs. More government energy needs to be put into developing palliative programs and extending hospice services.

End-of-life medical care is a significant indicator of how well our healthcare system is working for seniors. The pattern of care needs to be consistent with residents’ preferences and best possible quality of life, instead of with optimum profit margins. Unfortunately, although nursing home regulations are improving, abuse and neglect in these facilities remains a widespread issue. Senior abuse and neglect attorneys at Pintas & Mullins remind the public that these acts of negligence should never go unreported. If you or someone you love was the victim of abuse in nursing home, you have important legal rights, and may be eligible for compensation.