Hospice and Nursing Homes
By Jack Gordon, CEO, Hospice Foundation of America
(originally published in Journeys, August 2002)
[Note: Mr. Gordon served as Chairman and CEO of HFA until his death in
2005.]
Perhaps no group of terminally ill patients could benefit more from hospice care than those residing in nursing homes. Hospice-with its emphasis on patients' dignity, autonomy, comfort and freedom from pain-would seem to be exactly what terminally ill residents need. Unfortunately, few are getting it. The greater misfortune, however, is that they could get it-at least in theory.
Not everyone knows that Medicare pays for hospice care in nursing homes, even though it pays for virtually no other care delivered there. The same Medicare benefit available to you or your spouse in your family home is also available to a patient whose place of residence happens to be a nursing home.
Why, then, is hospice not more fully utilized in nursing homes?
Many factors impede what would otherwise appear to be a logical development. These include government regulation (both state and federal), a mandated focus on rehabilitation, the relentless drive to contain costs, and overworked aides and other staff who lack specialized training in end-of-life care. The fact that nursing homes and hospices operate under different sets of government regulations means that written contracts must be developed to make partnerships possible.
Nursing homes and hospices trying to work together to facilitate hospice care must struggle to overcome these obstacles. The result is that only a small percentage of nursing home residents actually receive hospice services. Most nursing homes do not have even one terminally ill patient receiving hospice care.
Yet long-term care settings, especially nursing homes, are exactly the places where issues of dying, grief, loss and bereavement should be the focus of ongoing concern and special sensitivity.
Over 1.5 million older Americans live in about 17,000 certified nursing homes in the U.S. More than 20 percent of all deaths in the U.S. occur there. In addition, 800,000 older persons reside in assisted living facilities, and another 600,000 live in continuing care retirement centers.
For advocates of hospice, this is the challenge of the future. You may wish to encourage your local hospice to take the first steps.
