MEDICAL EXPRESS
A Rutgers Health analysis of millions of Medicare records has laid the groundwork for improving end-of-life care by demonstrating that nearly all older Americans follow one of nine trajectories in their last three years of life.
“Identifying which paths people actually take is a necessary precursor to identifying which factors send different people down different paths and designing interventions that send more people down whatever path is right for them,” said Olga Jarrín, the Hunterdon Professor of Nursing Research at Rutgers and corresponding author of the study published in BMC Geriatrics.
The team pulled the final three years of clinical records from a randomly selected 10% of all 2 million Medicare beneficiaries who died in 2018. Analysis of how much personal care each patient received and where they received care revealed three major care clusters—home, skilled home care and institutional care. Each cluster contains three distinct trajectories.
Roughly 59% of patients fell into the “home” cluster, meaning they spent most of their last three years at home while friends and family helped them with any tasks they couldn’t do for themselves. Such patients typically received little professional care, either in their own homes or in nursing homes, until the last year of life.
Another 27% of patients fell into the “skilled home care” cluster, meaning nurses and other skilled professionals helped friends and family care for them inside their own homes for most of their final three years.
The final 14% of patients fell in the “institutional care” cluster and spent most of their final three years either in hospitals or (more commonly) nursing homes, receiving nearly all necessary care from paid professionals.
