LAUSR

The first M of the 4Ms Framework for Age-Friendly Healthy Systems (what matters, medications, mentation, and mobility) refers to understanding the values of older adults and establishing their preferences for care across the continuum. 1 For older US adults at the end of life, a “what matters” chasm has formed between the estimated 70% who express a preference to die at home and the 30% who actually do. 2 This discordance could be attributable in part to the variable access to and underfunding of home and end-of-life care across the US. An increasing number of people growing older with serious illnesses and dying at home will need home and community-based services (HCBS) to help with activities of daily living and staying independent. 3 However, the US health care system does not place enough emphasis on or provide sufficient funding for HCBS and is not ready for the seismic shifts toward more in-home deaths anticipated with the aging population during the next decade. Policy makers must allocate more resources to HCBS and increase access to early palliative care to ensure patients and their families have all they need in place for a peaceful death at home if that is desired. cross-sectional regression analysis of from