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A variety of factors probably contribute to our findings. Hospice, which for 35 years has provided team-based care, usually at home, to those nearing the end of life and remains enormously successful and popular, is under­utilized. Most people enroll in hospice fewer than 20 days before death, despite a Medicare benefit that allows patients to stay for up to six months. Hospice enrollment has been shown to be highly dependent on the type of doctor that you see. In fact, one study among cancer patients with poor prognoses showed that physician characteristics (specialty, experience with practicing in an inpatient setting, experience at hospitals, etc.) mattered much more than patient characteristics (age, gender, race, etc.) in determining whether patients enrolled in hospice. For example, oncologists and doctors practicing at nonprofit hospitals were far more likely than other doctors to recommend hospice.



A few years ago the Michigan city of Grand Rapids was awarded the title of Beer City, USA — a momentous honor that celebrates the city's bevy of craft breweries and a gentry that love drinking them.Now, the city is being recognized for something a little less ... lively.In a data analysis of 300 U.S. cities, Grand Rapids was named the best place in the country to die.So, what does that mean exactly? Well, it means, in essence, that more dying people are given hospice care for a longer duration of time in Grand Rapids than in any other place in the country. It also means those people are given hospice care at home, where they will ultimately die.In a study published in the, two researchers evaluated the 300 cities based on seven markers of end-of-life care quality, which includes hospital deaths, hospice use, and the number of doctors a person sees in their last year of life.Two other Michigan cities — Petoskey and St. Joseph — also made the top ten list. The Bronx, Manhattan, and St. Petersburg, Fl. were named the worst places in America to die.