A Study Of How Americans Die May Improve Their End Of Life

[Judi Lynn]

January 24, 2024 Rutgers University

A Rutgers Health analysis of millions of Medicare records has laid the groundwork for improving end-of-life care by demonstrating that nearly all older Americans follow one of nine trajectories in their last three years of life.

“Identifying which paths people actually take is a necessary precursor to identifying which factors send different people down different paths and designing interventions that send more people down whatever path is right for them,” said Olga Jarrín, the Hunterdon Professor of Nursing Research at Rutgers and corresponding author of the study published in BMC Geriatrics.

The team pulled the final three years of clinical records from a randomly selected 10 percent of all 2 million Medicare beneficiaries who died in 2018. Analysis of how much personal care each patient received and where they received care revealed three major care clusters – home, skilled home care and institutional care. Each cluster contains three distinct trajectories.

Roughly 59 percent of patients fell into the “home” cluster, meaning they spent most of their last three years at home while friends and family helped them with any tasks they couldn’t do for themselves. Such patients typically received little professional care, either in their own homes or in nursing homes, until the last year of life.

More:
https://scienceblog.com/541938/a-study-of-how-americans-die-may-improve-their-end-of-life/

[bucolic_frolic]

1. Been there, done that. Observations

Outside evaluation is the smartest investment one could make. It ought to be mandatory. Begun with the best of intentions and resources, caregivers grow tired with despair as the patient declines. Caregivers need independent advice and respite particularly in the last 9 months of life. When increased diligence is most needed, caregivers are most stressed and exhausted. Doctors will be only too willing to run every last test to make money, and the patient will be fatigued by the rigorous routine to the point of asking "Is this necessary?" Professional companies will visit and evaluate - for a hefty fee, and not due to a doctor's recommendation. I don't recall Medicare offering such. And home care is not covered except upon hospital discharge, and private care is expensive. Medicare might save a lot of money if they could prevent falls and shorten hospitalizations.

[Backseat Driver]

2. Simply, no matter what care pathways had been experienced throughout the earlier 3 years, the patient died in 2018.

Would that a life-extending course of treatment/care at less cost be promoted during a lifetime of awareness, at some point before and during the three years studied, there are likely ocassions that require more institutional care situations that rapidly evolve on which physicians may or may not make recommendations when requested, if indeed they are even advised about the incident, or based on best guess prognoses to caregivers themselves and their mental/physicial health requirements, that have higher costs -- in the end, those decisions may or may not be relevant to the initial patient living longer, but not in this study! Simply put, the stress of the living kills patient(s) and reduces both caregiver and patient's time left over and above the three years studied. Duh! They died! Likely the caregivers' health and longevity may have even been at risk leading to the studied patients demise.

Now, how much money was used up to study competent care at home or insistence on incompetent patient/caregiver choices at home? The paying programs already claw back 5 years of look-back. Those patients and their caregivers alike don't really know when their end(s) will come--tomorrow on the road to an appointment, a tumbling fall at home, failure to take a prescribed pill? Diet? Mental health lapses unreported in initimate settings? Lack of communication skills? Loving serene hugs won't change much! Hospice/palliative programs should make psychological exams mandatory! Costs are what they are in any future year; people make ackward choices. I think a "death benefit" for caregivers (when servicing as such at home for a patient) might be beneficially included in government programs(s), perhaps even free provided links to Go Fund Me requests for some griefing survivors.