– Home-based care is a leading outcome for older Americans in their final years
– A study by researchers at Rutgers University analyzed Medicare beneficiaries who died in 2018
– The study found that over half of Medicare beneficiaries were in home-based care, with the rest split between skilled home care and institutional care
– There were variations by state in the use of services during the last three years of life, with some states having a higher percentage of home-based care
– The findings are consistent with other studies that show a preference for aging at home and a downward trend in deaths in acute care hospitals
– However, 40% of older adults had major health service needs, indicating the need for more research to understand these preferences and improve the care experience
– Understanding the factors that influence place of care trajectories can help refine the care experience, improve health outcomes, and reduce care costs
– Aging-in-place preferences and long-term care are important considerations for older Americans
– The findings of the study may have implications for the reverse mortgage industry, as it aims to support aging in place goals.
While individual needs and health issues will primarily dictate how a person spends their final years, a new study shows that home-based care is a leading outcome for older Americans. This conclusion comes from a new study by researchers at Rutgers University in New Jersey. Hospice News first reported the findings.
“The aim of this study was to determine the trajectories for place of care in each quarter during the last three years of life among Medicare beneficiaries and the factors associated with these trajectories,” the researchers explained. “A retrospective cohort was assembled from Medicare beneficiaries who died in 2018, and a 10% random sample of the cohort was analyzed.”
The final results were ultimately sorted into three predominant “clusters,” they explained, including home care, skilled home care and institutional care. The far-and-away preference for the sample was in some type of home-based care, according to the findings.
“Nationally, over half (59%) of Medicare beneficiaries were in the home cluster, one-quarter (27%) were in the skilled home care cluster, and the rest (14%) were in the institutional cluster,” the researchers said. “There were large variations by state in the use of services during the last three years of life.”
Home care without a skilled nursing element was most frequent among Medicare beneficiaries in Alaska (81.5%), Puerto Rico (81.4%), Hawaii (72.9%), Arizona (69.2%) and Oregon (68.9%). They were least frequent among beneficiaries from Massachusetts (47.1%), Louisiana (47.8%), Rhode Island (48.3%), and Connecticut (48.6%).
“Our findings are similar to those reported in a recent prospective cohort study using a representative sample from the National Health and Aging Trends Study (NHATS), which also found that 58% of NHATS participants remained at home and 17% transitioned to or died in an institutional setting,” the Rutgers study found. “Our findings are also consistent with the recent downward trend of deaths in acute care hospitals and upward trend of deaths in home and community settings.”
Still, while the primary preference appears to be aging at home, more information is required to fully understand these preferences, the researchers concluded.
“While the majority of older adults spent their final years at home with minimal use of skilled home care or institutional care until the final months of life, 40% had major health service needs,” they said. “Extended use of skilled home care or institutional care was more frequent among older adults living with multiple chronic conditions, including dementia.”
Future research that aims to understand “the health care systems and policy factors that influence place of care trajectories” could help advance refinement of the care experience, health of the population and associated care costs, they added.
Aging-in-place preferences among older Americans are well documented, and the drivers of these preferences have also been subjects of recent discussion. Long-term care is also an increasingly large priority for older Americans.
The reverse mortgage industry often aims to position its product offerings as conducive to the goals of aging in place. The results of the Rutgers study may shed light on the broader considerations that lead older Americans to seek out certain end-of-life care paths, particularly as the U.S. population grows older more quickly.
Property Chomp’s Take:
According to the study, home-based care emerged as a leading outcome for older Americans in their final years. The researchers analyzed a retrospective cohort of Medicare beneficiaries who died in 2018 and found that over half (59%) of them were in the home care cluster. Another 27% received skilled home care, while the remaining 14% received institutional care.
The study also revealed significant variations in the use of services during the last three years of life across different states. For example, home care without skilled nursing was most frequent in Alaska, Puerto Rico, Hawaii, Arizona, and Oregon, while it was least frequent in Massachusetts, Louisiana, Rhode Island, and Connecticut.
These findings align with previous studies that have shown a preference for aging at home among older adults. The ability to remain in a familiar and comfortable environment, surrounded by loved ones, is highly valued. However, the researchers noted that 40% of older adults had major health service needs, which required extended use of skilled home care or institutional care, especially among those living with multiple chronic conditions like dementia.
Understanding the factors that influence the place of care trajectories is crucial for refining the care experience, improving the health of the population, and managing associated care costs. Future research should focus on examining the healthcare systems and policy factors that contribute to these preferences.
The preference for aging in place among older Americans is well-documented, and it has become a significant consideration in long-term care planning. The reverse mortgage industry, for example, often promotes its products as facilitating aging in place. The Rutgers study provides valuable insights into the broader considerations that drive older Americans towards specific end-of-life care paths.
As the U.S. population continues to age rapidly, it is essential to prioritize the development of effective and accessible home-based care options. By understanding the needs and preferences of older adults, policymakers and healthcare providers can work towards creating a supportive environment that allows individuals to age with dignity and receive the necessary care in the comfort of their homes.
In conclusion, the study by Rutgers University highlights the increasing preference for home-based care among older Americans. While aging at home is the primary choice for many, there is a need for further research to fully comprehend these preferences and address the healthcare and policy factors that influence them. By prioritizing home-based care options, we can ensure that older adults receive the appropriate support and care they need in their final years.