In Difficult Cases, ‘Families Cannot Manage Death at Home’

Symptoms and provide relief for malnourished families. Lead author, Dr. Melissa Wachterman, a palliative care specialist at Harvard Medical School, and her co-authors argue that alternative locations, including stand-alone inpatient hospices and hospital hospice units, could better care for some terminally ill patients with serious illnesses. They also say that financial incentives play a role in where death occurs.

“There is a strong cultural pressure: “If you loved this person, you would keep him at home,” Dr. Wachterman said. “We must recognize that there are people whose needs are so great that families cannot cope with death at home.”

Ninety-eight percent of Medicare-covered hospice patients receive “usual home care. The hospice organization sends nurses, assistants, a social worker, and a chaplain to the patient’s home and medicines and equipment, such as a hospital bed. But he can’t provide 24/7 care; it falls on family, friends, or out-of-pocket helpers.

Often this is enough. But death can follow an unpredictable trajectory, and some incurable conditions seem more suitable for the domestic end than others. Dr. Warreich’s analysis showed that cancer patients have the highest chance of dying at home. Patients with dementia are more likely to die in a nursing home, while people with respiratory problems are more likely to die in a hospital.

Some patients “may not need someone at the bedside 24 hours a day, ” they need someone available 24 hours a day,” Dr. Wachterman said.

A handful of hospice patients receive “continuous home care,” meaning nurses and assistants work eight to 24 hours a day; this represents 0.2 percent of days spent in hospice, according to Medicare Payment Advisory Panel, an independent agency that advises Congress on Medicare matters. Another handful receives inpatient services at a hospice, hospital, or nursing home.

Symptoms and provide relief for malnourished families. But inpatient care is hard to provide, accounting for just 1.2 percent of all days of hospice stay in 2019. To receive Medicare coverage, a patient must be diagnosed with a symptom that it cannot treat in other conditions, and “that’s a pretty high rate.” bar,” Dr. Wachterman said. Lead author, Dr. Melissa Wachterman, a palliative care specialist at Harvard Medical School, and her co-authors argue that alternative locations, including stand-alone inpatient hospices and hospital hospice units, could better care for some terminally ill patients with serious illnesses. They also say that financial incentives play a role in where death occurs.

“There is a strong cultural pressure: “If you loved this person, you would keep him at home,” Dr. Wachterman said. “We must recognize that there are people whose needs are so great that families cannot cope with death at home.”

Ninety-eight percent of Medicare-covered hospice patients receive “usual home care.” The hospice organization sends nurses, assistants, a social worker, and a chaplain. The patient’s home and medicines and equipment, such as a hospital bed. But he can’t provide 24/7 care; it falls on family, friends, or out-of-pocket helpers.

Often this is enough. But death can follow an unpredictable trajectory, and some incurable conditions seem more suitable for the domestic end than others. Dr. Warreich’s analysis showed that cancer patients have the highest chance of dying at home. Patients with dementia are more likely to die in a nursing home, while people with respiratory problems are more likely to die in a hospital.

Some patients “may not need someone at the bedside 24 hours a day, ” they need someone available 24 hours a day,” Dr. Wachterman said.

A handful of hospice patients receive “continuous home care,” meaning nurses and assistants work eight to 24 hours a day; this represents 0.2 percent of days spent in hospice, according to Medicare Payment Advisory Panel, an independent agency that advises Congress on Medicare matters. Another handful receives inpatient services at a hospice, hospital, or nursing home.

But inpatient care is hard to provide, accounting for just 1.2 percent of all days of hospice stay in 2019. To receive Medicare coverage, a patient must be diagnosed with a symptom that it cannot treat in other conditions, and “that’s a pretty high rate.” bar,” Dr. Wachterman said.