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The Very Best Places To Retire In America If You Are Sick

A Dartmouth study tells you where you'll get the best medical outcomes.

Most of those ubiquitous best-places-to-retire lists focus on where the sun shines the most or where your dollar will stretch the farthest. But leave it to the Dartmouth Institute for Healthy Policy and Clinical Practice to come up with a more pragmatic measurement: Where will you get the best health care as the ills of aging befall you?

The Dartmouth center analyzed Medicare data, looking for patterns of where medical care is both good and bad.

One thing the study underscores is that there is no uniformity in the care that older adults get and that there are some very troubling -- even dangerous -- places to live. Here are some of the study highlights:

1. Residents of Sun City make fewer trips to the ICU in their last six months of life with no negative effect on their outcomes.

Age-restricted communities such as Sun City market an active, social lifestyle that promotes overall health, the report notes. Dartmouth reported that residents of Sun City made far fewer trips to the ICU in the last six months of life than adults living in the rest of the country.

2. People in the Midwest wind up in nursing homes more than those on the coasts.

The average national percentage of Medicare beneficiaries who were long-term residents of a nursing home was 2.5 percent. The proportion of Medicare beneficiaries living in nursing homes in Mason City, Iowa was 6.2 percent. Major metropolitan areas such as San Francisco, Washington D.C., and Detroit were not particularly high areas for nursing home living.

3. The length of hospital stays varies greatly.

Getting the prize for the shortest hospital stays were the seniors in Bend and Salem, Oregon with just 1.4 days for Bend residents. On average, Medicare beneficiaries across the country spent 4.6 days in the hospital in 2012. But in Monroe, Alexandria, and Shreveport, LA., they spent more than seven days. States with high numbers of inpatient days included Illinois, Indiana, Kentucky, Ohio, Pennsylvania, and Louisiana. 

4. Same for late referrals to hospice.

Managing end-of-life care is a sensitive process. Referrals to hospice care that are done too late also adversely affect the quality of care, the reported experiences of patients and families, and their satisfaction with the health care system. Yet the percentage of Medicare decedents who were enrolled in hospice care within three days of their deaths varied more than fourfold. The national average was 16.8 percent. Rates of late hospice referral were low in the Bronx, New York (6.1 percent) but soared to 27.3 percent in Fort Lauderdale.

5. Using high-risk drugs.

On average, 18.4 percent of Medicare patients take what was categorized as high-risk drugs, many of which are anti-depressants. But in three regions of Louisiana -- Alexandria, Monroe, or Baton Rouge -- 27 percent to 29 percent of older adults get these drugs, almost three times more  than in Sioux Falls, SD or Mason City, IA.

 6. Thirty-day readmission rates matter -- and vary.

Hospital readmissions are one of those red flags that speak to the quality of care. While some readmissions are anticipated or planned to complete care, most are not and are instead caused by inadequate discharge planning or poor care coordination between the hospital and community clinicians. Patients with chronic conditions and high-need patients are at particularly high risk for readmission. In 2012, about 12 percent of beneficiaries discharged for medical reasons were readmitted within 30 days in Bend, Oregon but almost 18 percent of discharged medical patients were readmitted in Johnstown, Pennsylvania  and Dearborn, Michigan.

So what's the bottom line? Many retirees chose to move to wherever their adult children and grandkids are. Follow the heart, not the heart doctor, we think.

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