Hospice Care in Nursing Homes

Hospice care is specialised care given to elderly persons with terminal illnesses certified by a doctor to have a life expectancy of less than six months. Instead of treatment for the disease, hospice care aims to assist with pain, spiritual counselling, and grief support. Consequently, focusing exclusively on the individual’s quality of life and comfort.

Patients can receive hospice care at their place of choice, which could be their home, a hospital, a nursing home, or a hospice facility. Hospice care in nursing homes provides the patient and family additional support, which they sorely require. As a result, the person leads a comfortable end of life and spends quality time with loved ones.

What is Hospice Care? 

When diagnosed with a terminal illness with a limited expectancy of six months or less, dying patients may decide not to pursue medical treatments. 

It is essential to note that hospice care is for seriously ill hospitalised patients with incurable illnesses or those not responding to treatment. 

Patients who choose hospice care understand that their diseases are not curable or are not responding to treatments meant to slow the progress of the disease. The patient, therefore, decides not to receive treatment for the condition. In late-stage cancer cases, the patient may choose not to receive chemotherapy, surgery, radiotherapy, or any treatment to cure the disease or other symptoms at the nursing facility.

Medication provided in Hospice services

Medications provided in hospice service are meant to relieve pain and make the person as comfortable as possible during their end-of-life days. The patient’s family should consult their doctors on the available hospice care options as early as possible to fully benefit from this plan. As mentioned before, the goal is to have a better quality of life before the end of life.

Hospice teams can be headed by a medical director and they include medicare hospice doctors, hospice-trained registered nurses (RNs), hospice aides, volunteers, social workers, grief counsellors, and chaplains.

A senior living in hospice can discontinue the care at will or if their illness goes into remission and is no longer necessary.  To stop receiving medicaid services and hospice care, the patient signs a form with the date of terminating the treatment. The forms should not be signed earlier than the date of stopping the program. 

Who Pays For Hospice?

Hospice is covered by Medicare and Medicaid. Private insurance, veterans administration, and HMOs also cover national hospice for persons who are not eligible for these government programs. This ensures improved patient’s care for everyone including the underprivileged.

Hospice vs Nursing home

The difference between hospice and nursing homes is that nursing homes are meant to provide custodial care to elderly persons who don’t need hospitalisation but cannot be cared for at home. Hospice provides special care to terminally ill patients, including medication and specialised medical equipment.

Nursing homes offer the help needed by undertaking daily living tasks such as getting in and out of bed, bathing, dressing, and feeding. Also, these facilities have health care providers onsite to deliver the necessary care for effective pain and symptom management.

Persons needing hospice care require specialised end-of-life care that might involve certain medications. Traditionally, nursing home staff are trained in custodial care, which differs from that required in hospice care. For this reason, you need to check with the facility and see the services they offer. Nursing homes often fully or partially engage hospices to offer necessary help to terminally ill patients. 

Why do Nursing Homes Push Hospice?

The need for hospice services in nursing homes has been continually on the rise. When a loved one is diagnosed with a critical illness and has a limited time to live, families and friends can be extremely overwhelmed. In such cases, they require as much support as possible as they try to spend quality time with their loved ones for the remaining time. 

The need for hospice services is essential in nursing homes as it allows resident patients to access the special care they require during their last days of life. The care is not limited to medication but extends to specialised medical equipment required to assist these patients. As a result, these facilities can offer more comprehensive palliative care services to residents who need them. 

Benefits of Hospice in Nursing Homes

Do you wonder what the medicare hospice benefits are? In nursing homes and assisted living facilities, hospice offers end of life therapy services, end of life care, emotional support and pain and symptom management, through hospice nurses, etc.

Some key hospice benefits include:

  • Hospice reduces the need for constant rehospitalization for nursing home residents with terminal illnesses. 
  • Hospice manages the patient’s pain, allowing the family to maximise the time they have left with their loved one.
  • Assisted living hospice provides comprehensive care, which includes emotional and spiritual support to the patient in assisted living facilities and family members through these difficult times. Bereavement or grief counselling is also available to also provide emotional support to the family for a specified period (often 13months) following the end of life of a loved one.
  • Hospice for the senior living in nursing homes creates unique access to critical medical social services, medicaid services and palliative care.
  • Provides an opportunity for the patient to plan and make decisions regarding their end-of-life care. They can decide how to handle their dying process, etc.

Hospice in Nursing Home Regulations

Hospice care is only provided to terminally ill patients when a health care provider certifies that they have less than six months to live if the disease takes its natural course. Also, patients in hospice care should be informed of their rights and obligations before they enrol. 

The patient should sign a statement choosing hospice care and waiving any form of treatment to cure the illness. And if the patient is not in a state to provide consent, the family can do so. 

Hospice care for elderly doesn’t rule out the need for medication to manage symptoms and treatment for other conditions by the patient’s primary caregiver. For instance, a terminally ill patient with cancer who chooses hospice care can still receive treatment for diabetes or hypertension. The hospice provider will allow all the patient’s needs to be met and to begin, stop or restart treatment at their will.

Hospice for elderly is not limited to cancer patients, as it also applies to their illnesses. Also, the prediction of how long a patient will live by doctors is not always certain, and hospice patients can live for more than six months. 

What rights do hospice patients have?

To ensure a standard of care under the Federal hospice program “medicare,” the US government provides certain rights for hospice patients, which include:

  • Patients and their family members should receive a written and spoken list of their rights and obligations in advance of care during the initial assessment.
  • Patients and their property should be treated with respect. They should also voice their grievances regarding treatment and care free of discrimination and retaliation.
  • All alleged violations, such as abuse, neglect, and mistreatment by a skilled nursing facility should be reported immediately and investigated.
  • Patients have the right to receive effective pain management through palliative medicine, choose their attending physician, participate in developing their hospice care plan, refuse care or treatment, and be informed of the services covered under their hospice benefit.
  • After electing hospice care, hospice registered nurses offering medical care and palliative care must complete an initial patient assessment within 48 hrs. 
  • A comprehensive assessment by an interdisciplinary hospice staff should follow within five days. It must include information and data allowing for measurable outcomes, measured and recorded on an ongoing basis.

Hospice Fraud

The rate of hospice fraud in nursing homes has increased with the increasing demand for services. Also, hospice providers target nursing homes as a potential source of clients. As a result, they form relationships involving kickbacks and referrals. These financial relationships between nursing homes and hospice providers have led to patients receiving sub-standard services which are legally and medically inappropriate. Under the anti-kickback statute, the law states that “it is illegal to knowingly or willfully solicit, receive, offer or pay anything of value to induce referrals or items or services payable by a federal healthcare program.” 

Other common methods of fraud include:

  • Admission of patients who don’t meet the hospice criteria
  • Wrongfully retaining hospice patients whose health is improving
  • Issuing of kickbacks to hospitals and nursing homes for referrals
  • Excessive and unnecessary billing of hospice care
  • Bonus payments based on the number of patients admitted
  • Falsifying patient records to justify the retention of a patient
  • Retaining patients under hospice care without any justification
  • Failure to carry out the necessary patient re-evaluation
  • Lack of sufficient medical records to justify the need for hospice care

What does hospice care entail?

Hospice facilities differ in their procedures. However, they offer similar services, which include:

  • Palliative care and symptom control- a palliative care organisation will offer care as early as possible to prevent and treat a disease’s side effects and symptoms. This form of care aims to make the patient as comfortable and alert as possible and allow them to enjoy their last days of life. Specialised hospice professionals are also involved in providing physical, mental, social, and emotional care. 
  • Inpatient hospice care- even when provided in a nursing home, hospice care patients might be taken into an extended care facility, hospital, or an inpatient hospice centre. During these periods, the patient has the right to decide and choose the care of choice.
  • Spiritual care is essential to hospice care and is offered per the patient’s spiritual and religious beliefs. It helps the patient with religious ceremonies, understanding the concept of death, and saying goodbye.
  • Regular family meetings with the social worker or hospice nurse help keep the family informed of the patient’s condition and expected outcomes. The family members get to discuss events, share their feelings and learn about the death process. Through these meetings, the family can prepare for death and release stress.
  • The hospice doctors provide quality medical care throughout the entire period, and the patient can contact them with any concerns 24 hours a day.
  • Respite care is available for persons receiving hospice services at home to relieve family and friends caring for the ill patients needing health care.
  • Bereavement care – hospice care teams provide bereavement services for the loved ones following the loss. It involves the support of a professional counsellor, clergy member, or a trained volunteer through phone calls, visits, and support groups. Hospice teams can also refer the bereaved for further professional assistance whenever necessary.

Final thoughts

The comprehensive service provided by hospice care in nursing homes through a specialised hospice physician provides a smooth transition in the event of end of life resulting from a terminal illness. Medicare certified hospices are growing in popularity as people continually appreciate the benefits. Nursing home patients must understand their rights concerning hospice care to make informed decisions and make the most of their time with their loved ones during their last days of life. 

It’s not enough to only spend the last days of your life fighting for your health, you also need to enjoy life, something that most health care systems cannot provide. Hospice care in nursing homes grants nursing home residents a chance for symptom management as well as fulfilling end of life care.

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