Are Dying Seniors Getting The Care They Need?


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.

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When my father was in the hospital before he died, I was asked to find a place to discharge him to. The social worker at the hospital gave me a list that had the names of many SNFs. Hospice was not among them. I spent the last day before my father died looking at SNFs to pick out one. When I came to the hospital on his last day, I told the social worker I wanted to bring in Hospice. When I said those words, everything changed. It was like magic. I wish I had said them when he first went in. Hospice was called in, but my father died a few minutes before they got there. He lived his last few days in pain because the doctor wouldn't prescribe anything strong enough. He endured PT and OT when he was too weak to even stand. If I had just known to say "I want to bring in Hospice," it would have all been different.

When it is obvious that someone is dying, I don't know why the hospitals do not present Hospice as an option.
my mom is in stage 5 of alzheimer's what is her life expectacy after stage 5.
Absolutely we need a better structure of care for the elderly near the end of their lives! There should be no financial obstacles to electing Hospice Care when it is appropriate. It doesn't make sense that it is more economical for an individual to select skilled nursing when hospice is less costly to the system. And it doesn't make sense to require a dying person to go through the process of qualifying for Medicaid just so they can have hospice care in a nursing home.

If we put our minds to it, and if we didn't allow either political party to take credit/blame for the results, I am certain we could come up with far better ways to handle end-of-life care!