Home-Based Patients Report Higher Satisfaction with End-of-Life Care

Patients who receive care in their homes at the end-of-life report higher satisfaction with the medical services provided to them than those in other settings. New data indicate that place of death may be an important quality measure for end-of-life care. 

Analysis of data from the National Health and Aging Trends Study (NHATS) for 1,500 deceased Medicare Beneficiaries found that patients suffering from cognitive impairment were mostly to die at home, whereas cognitively healthy patients were equally likely to die in the home or a hospital. 

“Our findings suggest that older adults’ preference for place of death should be a central component of advance care planning, and the receipt of hospice care may be a key to achieving that preference,” said the study’s lead author, Natalie G. Regier of Johns Hopkins University School of Nursing. 


About 80% of people in the United States say they would prefer to die in their homes, according to the U.S. Centers for Disease Control & Prevention. Nevertheless, nearly 60% die in hospitals and 20% in nursing homes.

The study, published in the Journal of the American Geriatric Society, found that cognitively impaired patients who elected the Medicare Hospice Benefit were 14.5 times more likely to die at home than in a hospital, and 3.4 times more likely to die at home than in a nursing home. Cognitively healthy individuals who elected hospice were more than six times more likely to die at home than in a hospital and more than twice as likely to die at home than in a nursing home.

Families of patients who ended their lives at home reported higher satisfaction with their love one’s care that patient who died in a hospital, the study found.


With U.S. Centers for Medicare & Medicaid Services (CMS) publicly reporting hospice quality data, hospices need to take a sharp look at their quality indicators to successfully operate in newly available value-based care programs, such as the hospice demonstration of the value-based insurance design model that launched Jan. 1, as well as the Primary Cares Serious Illness Population model and direct contracting.

Payers, referral sources and a rising number of families are increasingly using these data when choosing a hospice to work with or to care for their terminally ill loved one. 

Among the most important sources of data is the Consumer Assessment of Healthcare Providers and Systems (CAHPS) survey.For hospice, CAHPS surveys are sent to the family after the patient has passed away to gauge their satisfaction with the care their family member received. The survey vendor contacts the family by phone or mail approximately 42 days after the end of the month in which the patient died.

The recent place-of-death research found that hospice utilization was the strongest predictor of whether a patient would spend their final days in their homes. Utilization has been steadily rising in recent years, reaching a record high of 51% during 2019, according to the Medicare Payment Advisory Commission.

“In recent years, there has been a growing awareness in end-of-life care research that place of death may be an indicator of quality of care,” according to the study. “Interest in this relationship was largely prompted by the nding that, while older adults prefer to die at home, the majority of older Americans die in hospitals or nursing homes.”

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