U.S. Value: : 20.8%
Healthiest State: Utah: 14.1%
Least-healthy State: New York: 29.8%
Definition: Percentage of deaths occurring in a hospital among chronically ill Medicare decedents ages 65 and older
Data Source & Year(s): The Dartmouth Atlas of Health Care, 2016
Suggested Citation: America’s Health Rankings analysis of The Dartmouth Atlas of Health Care, United Health Foundation, AmericasHealthRankings.org, Accessed 2020.
WHY DOES THIS MATTER?
Dying in the comfort of one’s own home is preferable for most seniors, with free standing hospice facilities as a second choice. Preferences are not always honored, however, and some seniors live their last few days of life in a hospital despite wishes for hospice or palliative care. Following patient preferences has improved over time. Since 2000, the proportion of deaths in hospitals has decreased.
End-of-life care in a hospital carries a high economic burden. Researchers estimate that among Medicare beneficiaries who died in 2014, average Medicare payments totaled nearly $35,000per person, with more than $17,000 going towards inpatient hospital costs. Following patient preferences can reduce Medicare spending and improve the quality of end-of-life care.
WHO IS AFFECTED?
Factors influencing whether end-of-life care is received in-hospital or out include:
- Having a caregiver: Studies show patients without caregivers are more likely to die in an institution than patients with caregivers.
- Availability of hospital resources: Areas with abundant health care resources (such as available hospital beds or medical specialists) tend to see greater use of hospital care and intensive care use among patients with chronic conditions, even when outpatient treatment would suffice.
- Geographic region: The number of days spent in intensive care within the last six months of life varied by geographic region as well as hospital referral region, according to a 2016 Dartmouth Atlas Report. Other research shows urban areas with proximal hospital care reduces the likelihood that patient preferences are followed.
In many circumstances, dying in a hospital may be avoidable. Research shows family support, physician support and hospice enrollment improves alignment between preferred and actual place of death. Palliative care units in hospitals have been an effective strategy to reduce hospital costs and reduce the use of end-of-life intensive care treatments.
Advanced care planning is a valuable tool which allows older people to state their preferences for end-of-life care options, including wishes to die at home or in a hospice setting. The United States Department of Human Services offers resources to assist with Advanced Care Planning.