The Case for Hospice Care in Long-Term Care Environments

The Challenges and Opportunities in Providing End-of-Life Care in Nursing Homes

“…45 Some progress has been achieved in decreasing the regulatory constraints in delivering palliative care, although further improvement is necessary to incorporate fully the quality indicators of palliative care into the NH survey process. [45][46][47][48] Medicare reimbursement policies in NHs also promote restorative care over palliative care. Of the 44 Resource Utilization Groups (RUGs) that determine the reimbursement rates for NH care, the RUGs that include intensive rehabilitation services and technological interventions such as tube feedings and intravenous lines are reimbursed at a higher rate than those focused on personal care and symptom management.…”

“…62 Hospice agencies can provide expert symptom management, additional personal care services, spiritual counseling, and bereavement services, thereby augmenting standard NH care. 48,60,63 Studies have shown that hospice enhances families' satisfaction with EOL care in NHs 63 and decreases hospitalization rates of NH residents at the EOL. 64 Use of hospice services for some residents may also influence the care of other dying residents.…”

Perceptions of Coordination of Care Between Hospice and Skilled Nursing Facility Care Providers

“…As one study noted, both of these providers must comply with not only different regulations and reimbursement systems, but in addition they have very different levels of autonomy in their practices 23 . One example of regulations differences concerns the use of "as needed" medication.…”

Hospice Experience and Perceptions in Nursing Homes

“…2 In spite of serving as the setting for so many deaths, nursing homes are not prepared to care for the dying. 3 Policy and regulation have emphasized rehabilitative and restorative care with the goal of improving or maintaining the functioning of residents. Because of public concerns regarding quality of care as well as concerns about neglect, nursing homes have been forced to follow regulations, reinforcing the notion that residents can be restored to their preexisting condition.…”

“…Because of public concerns regarding quality of care as well as concerns about neglect, nursing homes have been forced to follow regulations, reinforcing the notion that residents can be restored to their preexisting condition. 3 For many, however, this type of care is inappropriate. The philosophy and goals of rehabilitation are often in direct conflict with the needs of dying people, resulting in poor end-of-life care.…”