July 12, 2016
Hospice or Skilled Nursing? A Difficult Choice
As it stands, Medicare will pay for hospice or skilled nursing (S.N.F.), but only rarely will it cover both at the same time, forcing families to make the difficult choice between the two.
For financial reasons most families opt for a skilled nursing facility, but where they save in money, they pay the price in other ways: they lose the visits by nurses and aides and social workers, the comfort care, the pain relief and the spiritual support that can make hospice such a godsend, whether patients are at home or in nursing homes.
A study based at the University of California, San Francisco, found ongoing repercussions in the percentage of people that died in hospitals or nursing homes opposed to their homes, when they used the S.N.F. benefit. Only 11 percent of people experienced the comfort of dying in their homes, versus those who did not use S.NF. who were much more likely to be enrolled in hospice — and 40 percent of them died at home.
The study revealed more than 4,300 patients with advanced dementia who died in nursing homes in 2006 and used the S.N.F. benefit within 90 days of their deaths. The purpose of Medicare’s paying for skilled nursing is to help patients gain strength and return home, or at least to improve their health. But physical therapy, for example, serves little purpose for those who are bed-bound, who are totally incontinent, who can’t feed themselves. These people aren’t going to get better, yet they received a number of medical interventions compared to those in hospice care.
Those using S.N.F. were significantly more likely to receive feeding tubes, intravenous fluids, injections and medications — none of which can stop or slow dementia, or improve quality of life. The Affordable Care Act calls for a demonstration project of “concurrent care,” a three-year experiment allowing up to 15 hospice programs around the country to enroll patients who can also continue to receive all the other services that Medicare covers, including skilled nursing.
Upon completion an evaluation is to be used to determine whether people can benefit from the combined services of hospice and skilled nursing and whether that may even save Medicare dollars. Unfortunately, the statute does not set a target date.
Read more:
http://newoldage.blogs.nytimes.com/2012/12/03/forced-to-choose-exploring-other-options/