Medicare Costs at End-of-Life Driven Largely by Daily Functioning

Researchers from the Mount Sinai School of Medicine in New York and the University of California in Los Angeles released the results of a study examining factors that influence the costs of end-of-life care on February 15, 2011. The study, “Determinants of Medical Expenditures in the Last 6 Months of Life,” led by Dr. Amy Kelley of the Mount Sinai School of Medicine, found that costs associated with end-of-life care rely more heavily on individual patient characteristics than geographic region, which was previously believed to be the primary driving factor behind end-of-life costs.  Frequent hospital stays mean higher end-of-life costs

In prior research, Medicare costs during the last six months of life were strongly correlated with a patient’s geographic location. Previous research didn’t account for individual patient characteristics, such as impairment, a decreased ability to perform one’s activities of daily living (ADLs) and a patient’s support systems. This current study examined 2,400 older adults across the United States and took individual circumstances into account, as well as the characteristics of local health systems.

A person’s level of impairment and ability to perform ADLs was found to be a stronger predictor of higher Medicare costs than the person’s medical condition. Dr. Catherine Sarkisisan of UCLA says (as quoted on, “Having a caregiver available may help people avoid undesired hospital stays,” indicating that higher costs in the last six months of life could be attributed to more frequent hospital stays among older adults who lack sufficient support systems and don’t reside in a communal setting, such as assisted living or a nursing home, where caregivers and licensed staff are available to help residents 24 hours per day with their ADLs and other needs.

The study also found that advance care planning had no impact on Medicare costs near end-of-life, but having family nearby and dementia were associated with lower expenditures. A few chronic diseases, such as diabetes, were associated with higher end-of-life costs.

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