More Older Americans on Medicare Dying at Home

Experts say the lower numbers of disruptive hospital stays coincide with the timing of the dramatic program and policy changes to the U.S. health care system after 2009, most notably the adoption of the Affordable Care Act (ACA) in 2010, which had as a goal improving end-of-life care, including the growth of hospice and palliative care services.

As part of the ACA, hospitals were required to look at their hospitalization and readmission procedures. A 30-day rehospitalization penalty was enacted, which made acute care centers more accountable for where they were discharging patients and the level of care those patients would receive. There was also was an overall transition “from paying for volume [of services] to paying for value,” Teno says.

To make further gains, Teno says it is critical that we educate consumers about their care and the dangers of both overtreatment and undertreatment, and that we have a system of accountability for both errors. “And it is very important that we have a very frank conversation with people at this stage of life who are seriously ill about what’s important to them at this phase of life, their understanding of their prognosis, the seriousness of the illness that they are dealing with … and their treatment options. If they have wishes to avoid hospitalization and try to remain at home, we need to design a system to allow this.”

For the over-50 population, Teno points out how assisted living facilities now account for a “good portion of our community deaths,” which is a marked shift. Those who are looking into such facilities should take this under consideration. Says Teno: “If I am going to choose an assisted living facility, and I am in my eighth or ninth decade of life, I’d probably want to be careful that the assisted living facility provides high-quality medical care that meets my needs and preferences, including care at the close of life.”