An older person, someone who will die within six months, leaves a hospital. Where does she go?
Almost a third of the time, according to a recent study from the University of California, San Francisco, records show she takes advantage of Medicare’s skilled-nursing facility benefit and enters a nursing home. But is that the best place for end-of-life care?
In terms of monitoring her vital signs and handling IVs — the round-the-clock nursing care that the skilled-nursing facility benefit is designed to provide — maybe so. But for treating end-of-life symptoms like pain and shortness of breath, for providing spiritual support for her and her family, for palliative care that helps her through the ultimate transition – hospice is the acknowledged expert.
She could receive hospice care, also covered by Medicare, while in the nursing home. But since Medicare only rarely reimburses for both hospice and the skilled-nursing facility benefit at the same time, this hypothetical patient and her family face a financial bind. If she opts for the hospice benefit, which does not include room and board at the nursing home, then she will be on the hook for hundreds of dollars a day to remain in the facility.
She could use the hospice benefit at home, of course. But, “we know these patients are medically complex,” said Katherine Aragon, lead author of the study in The Archives of Internal Medicine, and now a palliative care specialist at Lawrence General Hospital in Massachusetts.
“And we know that taking care of someone near the end of life can be very demanding, hard for families to manage at home.” And that assumes the patient has a family or a home.
For some patients, a nursing home, though possibly dreaded, is the only place that can provide 24/7 care.
But if she uses the skilled-nursing facility benefit to pay for room and board in a facility, she probably has to forgo hospice.Blue Skies Hospice provides palliative care and visitation to many residents of nursing homes. It enjoys a relationship with nursing homes and long term care facilities in Northwest Indiana, and is able to fill in the gaps of people's treatment - people who are seeking the stability, care, and benefits of health care facilities, but also need, as Span identifies, the palliative treatment, emotional support, and spiritually edifying companionship that hospice provides.
If you are in the Northwest Indiana area and are preparing to put a relative in a long term care facility, you might want to consider asking if that nursing home has a relationship with Blue Skies, and if hospice care is available.
Blue Skies is only one hospice doing the best it can. As the study's author makes clear, the United States needs to move in a better direction, nationally - "Palliative care should be part of nursing home care,” said Alexander K. Smith, the study’s senior author and a palliative care specialist at the University of California, San Francisco. “And that regulation that prevents concurrent use of the S.N.F. benefit and hospice isn’t in the interest of patients and families.”
