Elderly patients trying to exert some control over where they die still face formidable obstacles, and may be determined as much by payment policies as by medical necessity or personal preference.
The Journal of the American Medical Association has published a new study that shows that a smaller proportion of Medicare patients were dying in hospitals at the end of the last decade than at the beginning.
The report indicates that is likely due both to increased availability of home hospice care and home care along with policies that discourage long hospital stays.
The numbers also show that nearly 30 percent of those who died in hospice were in that setting for three days or less, and of that group, 40 percent had been in a hospital ICU before they were transferred.
Access to hospice may be further complicated by who pays for care and complicated Medicare rules.