August 28, 2019

Many Medicare beneficiaries die within 5 years after a long-term care hospital stay, study finds

Daily Briefing

    Many Medicare beneficiaries who are admitted into long-term acute care hospitals (LTACHs) spend about 66% of their remaining life in an inpatient setting, and many die within five years, according to a study published Monday in the Journal of the American Geriatrics Society.

    What do consumers want from post-acute care?

    What are long-term acute care hospitals?

    LTACHs provide extended, complex, post-acute care to patients with debilitating conditions and injuries. The facilities are intended to help patients recover and regain their independence, Reuters reports. LTACHs are distinct from acute-care hospitals and skilled-nursing facilities because they focus on treating patients in need of extended inpatient care, according to Reuters.

    LTACHs typically treat sicker patients for an average of at least 25 days at a time. The facilities annually treat more than 120,000 Medicare beneficiaries, and they accounted for $5.4 billion of annual Medicare spending as of 2014, Reuters reports. However, there is little known about the long-term health outcomes of patients admitted to LTACHs, Reuters reports.

    Study details

    To address that lack of information, researchers from the University of California, San Francisco (UCSF) and the University of Texas Southwestern Medical Center examined the long-term health outcomes of 14,072 Medicare beneficiaries ages 65 and older who were transferred from an acute-care hospital to an LTACH from 2009 to 2013.

    Overall, the researchers found Medicare beneficiaries lived an average of 8.3 months after being admitted to an LTACH. The researchers found 45% of beneficiaries admitted to an LTACH lived one year after being admitted, and 18% lived five years after being admitted.

    According to the researchers, younger beneficiaries lived longer than older beneficiaries. In addition, beneficiaries with a musculoskeletal diagnosis lived longer than those with a primary respiratory diagnosis. Specifically, the researchers found beneficiaries:

    • Ages 85 and older lived an average of four months after admittance;
    • Between the ages of 65 and 69 lived an average of 17.3 months after admittance;
    • With a primary respiratory diagnosis lived an average of 5.3 months after admittance;
    • With a musculoskeletal diagnosis lived an average of 25.9 months after admittance.

    In addition, the researchers found Medicare beneficiaries admitted to LTACHs spent an average of 65.6% of their remaining lives in a hospital or another inpatient setting. According to the researchers, 36.9% of beneficiaries admitted to LTACHs died in an inpatient setting before they recovered—and, in many cases, those beneficiaries did not receive hospice care within their final days of life. The researchers said the low enrollment in hospice care among beneficiaries who were admitted to an LTACH represents a "potential missed opportunity to improve" their care at the end of their lives.

    Comments

    Anil Makam, the study's lead author and a researcher at UCSF, said, "The take-home message is that if your loved one is planning on going to an LTACH to recover, then chances are they are very sick and may be nearing the end of life." As such, Makam said that "[e]ven before going to the LTACH, [beneficiaries] should have an honest discussion with [their] doctors and those closest to [them] about whether staying in a hospital setting and undergoing invasive procedures is most closely aligned with [their] values and goals. For some the answer will be yes, but for others, they might prefer to focus on relieving their symptoms and optimizing their quality of life, even if that means they might not live as long."

    Jennifer Goldstein, a hospitalist with Christiana Care Hospitalist Partners who was not involved in the study, said, "Discussions with hospice and palliative care providers can be extremely valuable when making these decisions and considerable efforts should be made to include them in these discussions."

    Alok Kapoor, a researcher at the University of Massachusetts Medical School who was not involved in the study, said patients and families need to understand that older adults who are hospitalized have a longer and steeper road to recovery than younger adults. "Admission to hospital causes a number of different stresses on the body and brain of older adults," Kapoor said (Rapaport, Reuters, 8/26; Makam et al., Journal of American Geriatrics Society, 8/26; Lasek, McKnight's Long-Term Care News, 8/27; Maier, UCSF release, 8/26).   

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