Nursing homes will need hospice services
Nursing homes are increasingly providing hospice services to their residents, and the trend is expected to continue in the competitive long-term care industry, according to a study published in the Gerontologist.1
An estimated 13,369 Medicare hospice beneficiaries reside in Medicare/Medicaid-certified facilities on any given day. For the most part, the study says, hospice beneficiaries are being served in nursing homes that do not have specialized hospice units because only about 1.3% of nursing homes have such units. Nevertheless, residents of those nursing homes are more likely to receive hospice care.
The authors conclude that U.S. nursing homes are increasingly providing hospice services. They suggest the trend represents a deliberate management strategy for ensuring organizational survival in a rapidly changing and increasingly competitive long-term care market. Their investigation further suggests that that economically motivated path and the potential profit motive in health care may give rise to unequal service and access.
Nursing homes with higher percentages of residents receiving the hospice benefit are more likely to be for-profit, belong to a chain, and not provide full-time physician coverage. The proportion of residents receiving the hospice benefit increased in counties with fewer certified nursing home beds and in areas with more certified hospices, for-profit hospices or larger hospices.
The authors assert, however, that those developments are occurring in the absence of much-needed outcome data. While the significant variation in the distribution of hospice beneficiaries among states may be influenced by state Medicaid reimbursement rates and coverage policies, the findings of this study do not permit conclusions regarding the impact on individual residents. Also, because research has shown that in many health care settings "practice makes perfect," concentrating hospice patients in a relatively small number of facilities may be appropriate. The authors recommend further examination of the access and quality implications of providing hospice care to dying nursing home residents, in order to inform future public policy.
Reference
1. Petrisek AC, Mor V. Hospice in nursing homes: A facility-level analysis of the distribution of hospice beneficiaries. Gerontologist 1999; 39:3.
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