Patients, Families Overwhelmingly Prefer the Home as End-of-Life Setting, Researchers Find
McKnight’s Home Care | By Adam Healy
Patients and family members alike prefer the home over any other care setting for end-of-life care, researchers discovered in a review of more than 200 studies.
An analysis of all 229 studies found that as many as 89% of patients and 84% of family members prefer end-of-life care to be delivered in the home. The home is also the most preferred place of death, with more than half of patients indicating as such.
“There was consistency that home is the most favored place for EOLC [end-of-life-care] and death, both for patients and their families,” the researchers wrote in the review published by the Journal of Pain and Symptom Management.
Patients preferred to receive care in the home for a variety of reasons. Many reported feeling a sense of autonomy, dignity or peace at home, noting benefits such as being surrounded by family and friends. Caregivers, meanwhile, preferred patients experience end-of-life care in the home because many felt it respected the patient’s wishes and made their role as a caregiver more meaningful.
The Centers for Medicare & Medicaid Services has experimented with payment models that help keep end-of-life patients comfortably in their homes. A recent review of the Medicare Care Choices Model found that participants were able to spend up to five more days at home compared to those who were not involved with the program.
Still, a minority of patients and caregivers also indicated that they prefer other settings, such as hospitals, nursing homes or other facilities, for receiving care at the end of life. Some felt that clinical settings could provide better care, especially when the patient’s condition is especially acute. Home-based end-of-life care may also increase caregiver’s burden, or make it harder to connect with support when care is needed urgently.
And others may have no choice as to the setting in which they can receive care. Rural patients in particular might not have access to local providers, or resources to support home-based hospice or palliative care, which might affect some people’s decision-making.
“Some patients decide to sacrifice their preferences and move to another place, commonly to hospitals and hospice/palliative care facilities,” the researchers wrote.
“However, these care facilities are not available everywhere, especially in remote or rural areas, and the lack of support at home is critical to the decision.” |
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CMS’ New Behavioral Health Model Recognizes Seniors’ Complex Health Needs
McKnight’s Home Care
Increasingly, it seems, the Centers for Medicare & Medicaid Services is grasping the multifaceted health challenges facing older Americans, the value of community-based stakeholders as problem solvers and the importance of social determinants of health as key drivers of health. These keen insights were on display in CMS’ announcement Thursday about the new Innovation in Behavioral Health Model.
The model, which will launch in the fall and run for eight years, targets Medicaid and Medicare populations with moderate to severe mental health conditions and substance use disorder (SUD). As CMS notes, a quarter of all people enrolled in Medicare experience mental illness, and 40% of all adults enrolled in Medicaid experience mental illness or SUD.
Practice participants will be community-based behavioral health organizations and providers, including safety net providers, and public or private practices, where individuals can receive outpatient mental health and/or SUD services. These entities will lead interprofessional care teams and be responsible for coordinating with other members of the care team to comprehensively address a patient’s care to include behavioral and physical health, and health-related social needs such as housing, food and transportation.
This program is an important development for Medicare and Medicaid, the two major government programs catering to older and sicker adults. Those familiar with this demographic understand the prevalence of behavioral health problems and the cost implications of these problems on the healthcare system — in part through patients’ repeated hospitalizations.
Besides recognizing the need to serve this high-risk population, CMS is smart in recognizing how a patient’s care includes whole-person health — physical, mental and social health involving nutrition and housing. And how various community stakeholders need to work together to attack the problem.
“The systems of care to address physical and behavioral health conditions have historically been siloed, but there is a direct correlation between people with mental health conditions or substance use disorder and poor physical health,” Liz Fowler, CMS deputy administrator and innovation center director, said in a statement. “This model will bring historically siloed parts of the health system together to provide whole-person care.”
It would appear that home care has a part to play in this model. |
Hospital to Home
Accessible Systems
Join Accessible Systems for one or more of the following free, 1-hour CEU eligible webinars. Content is applicable to PTs, OTs, Nurses, Discharge Planners, Case Managers, Social Workers, Home Care Providers.
All webinars are held on the last Wednesday of the month at 12:00 PM (Mountain Time), with registration opening on the 1st of every month.
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