Hospice Services in Nursing Homes

Are hospice services underutilized because of fear and stigma? Many patients in nursing homes qualify for hospice care yet never receive it.  Why?

Vincent Mor, phD, a professor of health services, policy and practice at Brown University, noted that despite Medicare and Medicaid coverage, in-facility hospices remain rare in skilled nursing settings. Mor has researched hospice access for a long period of time, and even co-authored a paper 20 years ago that argued about the government concerns of possible abuse of the hospice benefit in nursing homes. Nursing homes typically have contracts with local hospices to “rent” beds, which are later staffed by external hospice employees to manage patient symptoms.

A 2019 LeadingAge study found that services remained “highly underused.” Studies showed that before the federal regulators proposed for reduction in hospice payments for patients that live in nursing homes, 24% of nursing homes residents that die in nursing homes were able to qualify for hospice services, but only 6% were enrolled.

Mor told McKnight’s, “But, having a dedicated inpatient unit located in a nursing home that offers short stays for symptom management or to allow people to die outside the hospital the same way a community-based hospice inpatient unit would is unusual.”

Mor stated that adding a hospice and palliative care unit is a significant investment, and that the regulatory review is extensive.

Masonic Villages Assistant Executive Director and Health Care Center Administrator, Matthew Mayo, told McKnight’s that the non-profit had been discussing the addition of a designated hospice unit, but had no space. After the pandemic and when census dropped, administrators made the change of adding 16 additional beds for hospice care. The non-profit had already been providing hospice care services for 13 years, and Masonic Village Hospice staff provided training.

Mayo admitted that his situation was unique as donors paid for all furnishings including beds, couches, TVs, and recliners. There was also an addition of a chapel, library, office space, and children’s playroom, all in house. Mayo said, “It’s not just for the residents, its also taking care of the families,” and “The future is to make sure our residents have a great experience, and families feel they’re well taken care of.

Andrew Salmon, chief future officer at Salmon Health & Retirement, said that transitioning and identifying to hospice care will lessen the impact that end-of-life patients may otherwise have on skilled nursing quality measures.