Nearly one-third of elderly Americans turn to skilled nursing care during their last few months of life, despite the fact that some may be better served by seeking palliative care services, such as hospice, according to a recent analysis published in the Archives of Internal Medicine.
Researchers from the University of California, San Francisco (UCSF) discovered that 31 percent of Medicare beneficiaries who were newly released from the hospital utilized the program's skilled nursing benefit (the program pays for up to 100 days of nursing home care if a senior was hospitalized for three or more days) in their last six months of life.
What was surprising was that many of these seniors failed to take advantage of Medicare hospice coverage during this time, even though elders who reside in nursing homes can apply to receive additional palliative care if they are close to death.
This finding raises the question of whether or not these ailing adults are getting the optimal care for their terminal conditions.
Skilled nursing facilities primarily deliver care aimed at either getting a senior functional and back on their feet, or prolonging their life through medical intervention. Hospice care, on the other hand, strives to help an elder (and their family) manage the physical and mental pain of a terminal illness such as cancer or Alzheimer's disease.
A case for a better benefits structure
Not all nursing homes are equipped with the staff and resources necessary to provide proper palliative care, according to commentary on the study, written by Peter Boling, M.D., of Virginia Commonwealth University.
"The use of the hospice care benefit improves the quality of end-of-life care processes for many patients in nursing homes," he says.
Both Boling and the UCSF researchers feel that cost considerations are compelling many Medicare beneficiaries to stick with skilled nursing care alone, rather than accept additional help from hospice providers.
A senior staying in a skilled nursing facility can apply to receive outside hospice care—if they have less than six months left to live. But Medicare's current benefits structure means they'll have to fork over more money for their living expenses (lodging, meals, etc.), either through private pay, Medicaid or supplemental insurance.
Study authors say dying seniors may benefit from a plan that better integrates palliative care services into Medicare's nursing home coverage.