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Rehabbed to Death: Breaking the Cycle.
Lynn A Flint1,2, Daniel David3, Joanne Lynn4
1School of Medicine, University of California, San Francisco, San Francisco, California.
Journal of the American Geriatrics Society
|August 29, 2019
Summary
Many older adults cycle between hospitals and post-acute care (PAC) facilities, a trend termed "rehabbing to death." This highlights systemic failures in geriatric care, necessitating policy and practice reforms for better end-of-life support.
Area of Science:
- Gerontology
- Healthcare Policy
- Palliative Care
Background:
- Older adults frequently transition between hospital and post-acute care (PAC) settings during their final life phase.
- The current healthcare system often fails to meet the complex needs of older adults and their families at the end of life.
- Misnomers like referring to PAC facilities as 'rehab' obscure the true nature of care provided.
Purpose of the Study:
- To advocate for critical practice and policy changes in geriatric care.
- To address the phenomenon of older adults undergoing repeated hospitalizations and PAC stays in their final phase of life.
- To improve alignment between healthcare policies and the needs of older adults and their caregivers.
Main Methods:
- Proposing a shift in terminology from 'rehab' to 'after-hospital transitional care' for PAC facilities.
- Recommending the adoption of serious illness communication strategies for end-of-life care discussions.
- Advocating for policies that promote comprehensive care planning and caregiver support.
Main Results:
- Implementing proposed changes can reduce the cycle of hospital-PAC-hospital transfers for older adults.
- Realigning policies can ensure care aligns with patient preferences and priorities.
- Improved communication and care planning can lead to better end-of-life experiences.
Conclusions:
- The current healthcare system's approach to post-acute care for older adults requires significant reform.
- Adopting person-centered language and communication models is crucial for improving geriatric end-of-life care.
- Policy changes incentivizing comprehensive planning and caregiver support are essential for dignified aging and dying.
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