Hospice Use Rises; So Does Aggressive Care

Joan Teno and her coauthors' analyzed the Medicare fee-for-service records of more than 840,000
people aged 66 or older who died in 2000, 2005, or 2009.  They looked at
where seniors died, what medical services were provided during their last 90
days of life, and how long they received them.  

In the latest issue of JAMA (free download), Teno et al. report that while more seniors are dying with hospice care than a decade ago, they
are increasingly doing so for very few days right after being in intensive
care. “For many patients, hospice is an ‘add-on’ to a very aggressive
pattern of care during the last days of life."  “

The consequence of this pattern of
going from the ICU to hospice is that "these dying patients are getting symptom control
late and can’t benefit as much from the psychosocial supports available were
there a longer hospice stay."  The authors blame both poor
communication and financial incentives.