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.