I had yet another person tell me today that they didn’t know that a person who lives in a nursing home can also be on hospice, and I replied with my stock answer, which is, “I think that’s Medicare’s best kept secret.” I have no clue how many times I have said that line.
What I want to explore though is the question of whether or not a nursing home patient should be allowed to be on hospice. I know many doctors say no, because it is duplication of services. I say hogwash. Many people say that hospice does just as much for nursing home patients as it does for home patients. I say hogwash. (I just became a very unpopular member of the hospice community by saying that out loud!) The truth of hospice care in a nursing facility is somewhere in between.
Should hospices be allowed to care for (read: paid for) patients in a nursing home? I can not emphasize how much I believe they should. Somewhat by definition, a hospice patient requires more care than your typical nursing home patient, and if you’ve been in an average nursing home lately you know that the typical nursing home patient doesn’t get the care they need. Nursing homes are understaffed and generally the best homes provide adequate care at best. We won’t even talk about the bad homes. Now, if the staff of the home is stretched thin on a normal day, what happens when a patient needs extra attention? Either that patient doesn’t get it, or some other patient in the building is neglected so that the special needs patient can be cared for. This is where hospice earns it’s money. They provide the care that the terminally ill patient needs with more skill than the nursing home staff could or would, and allows that staff to continue to do their job. There is no doubt in my mind that hospice is a good thing for nursing home patients. Hospice workers are experts in caring for the terminally ill. If someone with a terminal illness resides in a nursing home, they should have access to the experts.
Now, for the paragraph that will make me the least popular hospice owner in the land. Hospices market nursing homes like drug companies market doctors because there is a lot of money to be made in nursing facilities. Medicare pays us the same amount for a nursing home patient as it pays us for a home patient. With every home patient there is the possibility that we will have to use our staff to give the patient a bath seven days a week,; at the nursing home we only do it on days that the facility isn’t supposed to. At home, we may have to give the patient medications; at a nursing home the facility is in charge. At home, we make a visit every time there is a change in the patient; at a nursing home their nurse often takes care of the minor problems. At home, we rent beds and shower chairs for our patients; at the nursing home those things are already in place. There are hospices that almost exclusively take nursing home patients (and they make me mad) because you can get rich off nursing home patients. Home patients are a much larger financial gamble. Look around. Almost every big nursing home company owns their own hospice. Why? Because they have seen what hospice gets paid and exactly what they do in the nursing home. They know the dirty secret. Medicare is paying too much for hospice/nursing home patients.
Again, I want to emphasize the fact that I believe with all my heart that hospice is a good thing for the terminally ill population of a nursing home. In fact I think it is a great thing!
Here’s to Medicare figuring out that there is a difference in the services provided to a nursing home resident and a home patient. Here’s to them lowering the pay-rate for those nursing home residents. AND here’s to them raising the pay-rate for home patients so that those of us who just want to take care of people no matter where they live don’t have to see home patients as a financial risk any longer!