Despite efforts to reduce aggressive and expensive care for the terminally ill, a greater percentage of dying Medicare patients underwent hospitalization in their last 90 days—not fewer—and more patients spent time in intensive care units in their last month in 2009 than in 2000, says a surprising report.
The study, published in the Journal of the American Medical Association, found that the percentage of patients hospitalized in their last 90 days of life went from 62.9% in 2000 to 69.3% in 2009. And the percentage of patients who spent time in the intensive care unit in their last 30 days went from 24.3% to 29.2%.
Joan Teno, MD, lead author of the report and a health policy and practice professor at Brown University in RI, says such patterns of more aggressive care "is really only ethically defensible if that's what the patient wanted," and she doubts that more patients are wanting that level of intensity.
Rather, she says, her own research and that of others, shows that patients and their families are not getting the opportunity to make such choices.
Her report did find that a larger percentage of patients are dying at home, and far fewer are dying in acute care hospitals. But more patients are being moved around from one care setting to another in the last 90 days of life as well as in the last three.