Nursing homes can be a refuge for older adults, offering a place to live, sleep, eat, socialize and receive medical care to support healthy aging. But as health declines with age, some people in nursing homes may find that they are no longer interested in undergoing medical treatments and instead want to receive care that keeps them comfortable and pain-free. People seeking this type of medical support may benefit from hospice care, which can be offered at a nursing home.
Switching to hospice care at a nursing home can be a big decision — but a rewarding one too. To make sure you or your loved one is ready to make the change, consider the differences between how nursing homes provide hospice treatment and skilled nursing care, and how you’ll fund the transition.
[READ What Is Palliative Care, and Can You Get It at Home?]
Hospice and Nursing Homes
If you or your loved one are considering hospice care at a nursing home, you’re likely experiencing — or witnessing — a decline in health and seeking medical care that provides comfort but not a cure. Hospice care can be beneficial for patients who are terminally ill and are comfortable with the possibility of dying, as hospice can offer them a sense of control over their medical decisions, or lack thereof, during health declines. However, not everyone in a nursing home will want to — or is qualified to — pursue hospice care, and this is a decision that must be made with thought and care with your loved one and their doctors.
To qualify for hospice care covered by insurance, a terminal condition must be present. For hospice care covered by the Medicare Hospice Benefit, a doctor must first certify that the patient has six months or less to live. That doesn’t mean death is inevitable within six months, however, and many people may continue receiving hospice for longer than this if their condition warrants recertification.
To receive hospice coverage, it must be actively elected by the patient or their legal representative — and hospice cannot be forced against someone’s will. Lori Schoener, administrator of skilled nursing at Brethren Village, a retirement community and nursing home in Lancaster, Pennsylvania, says that before a resident transitions to hospice at BV, the staff facilitate thoughtful conversations with nurses, doctors and family members.
“Our nursing team monitors all of our residents, and if we see somebody in a decline — which can be a quick decline or a slow decline — we would talk with that resident’s doctor,” Schoener elaborates. Their doctor would then work with the resident and their family to weigh their options.
[READ: Taking Over Affairs for an Aging Parent in Mental Decline.]
When to Transition to Hospice Care in a Nursing Home
According to Schoener, some signs of decline that could warrant a family-doctor conversation include:
— Loss of appetite accompanied by significant weight loss
— Residents becoming more easily fatigued
— Loss of ability swallow easily — in particular for residents with Alzheimer’s or other forms of dementia
— For residents with chronic conditions, an increase in symptoms that are becoming more difficult to treat
Depending on the resident’s cognitive state, they may or may not be an active participant in conversations about hospice. At BV, if the resident still has “decision-making capacity,” they will be involved in conversations about hospice and group meetings with their family and medical provider, Schoener says.
From there, the family and resident would decide if they want to pursue hospice and if so, what hospice provider they prefer to work with.
In addition to signs of health decline, some signs that hospice care at a nursing home may be appropriate include:
— A terminal illness diagnosis
— Certification by a medical doctor as having six months or less to live
— Preference of comfort over medical treatments trying to improve health
— Comfort with or readiness to accept the possibility of dying
— Discussions regarding declining health and the possibility of hospice care at the nursing home
“There are a lot of benefits to hospice service and the support that they can provide,” Schoener says. While it can be difficult to watch a loved one enter hospice care, “it also brings peace to families when everybody understands that this is the point we’re at.”
[READ: What to Say to Someone Who Is Dying]
Difference Between Hospice and Nursing Home Care
Receiving hospice care at a nursing home is different than receiving skilled nursing or custodial care at a nursing home.
What is skilled nursing or custodial care at a nursing home?
Many nursing homes offer skilled nursing services and custodial nursing services. Patients receiving skilled nursing services may receive treatments for chronic illnesses and services like rehab and post-surgical recovery treatments after a hospital stay. If you’re transitioning from skilled nursing to hospice, most of these services will no longer be available to you.
Patients may also receive custodial care services at a nursing home, which include non-medical services like changing soiled sheets and providing meals. Typically, residents who receive skilled nursing services also receive custodial services. In some places, residents may choose to live at a nursing home solely for custodial services. If a resident is on hospice care at a nursing home, they should also receive custodial services.
Skilled nursing treatments vs. hospice treatments
Skilled nursing treatments are medical care and therapies focused on getting a patient better, whereas hospice centers on comfort-focused medical treatments with the goal of achieving or allowing for a peaceful end-of-life experience.
Dr. Brian Madden, a primary care physician and medical director of palliative care at Providence Saint John’s Health Center in Santa Monica, California, explains that typically, much of skilled nursing is focused on rehabilitation — tools like physical therapy, occupational therapy or speech therapy, with the “goal of trying to restore you.”
In contrast, hospice care is focused on reducing pain and increasing comfort, using tools like oxygen, pain medications or special chairs, depending on an individual’s needs.
Hospice Care in Nursing Homes
While skilled nursing treatments are typically provided by nurses and doctors on staff, hospice treatments will likely be offered by a separate hospice team — which may be outsourced or have a contract with the nursing home. At Brethren Village, Schoener says the facility has contracts with a few hospices in the area — which patients can choose from when they are ready for hospice. If they’d prefer to work with a hospice provider that does not have a contract with BV, she adds that the facility can make arrangements for this too.
What hospice care looks like at a nursing home can vary based on what your facility offers, what your hospice team offers and what your medical needs are. After you decide that you are ready for hospice, your doctors will come up with a plan that is right for your needs — and your care will be transferred over from nurses with the nursing home to nurses with the hospice provider. When this happens, skilled nursing treatments will stop but your custodial services will continue.
Your hospice program may also offer some new services or medical equipment that your skilled nursing team was unable to offer.
[READ: Nursing Home Care: Where Does My Money Go?]
Who Pays for Hospice Care in a Nursing Home?
Paying for hospice care in a nursing home is complicated and can be more pricey than staying at a nursing home for skilled nursing care.
Simplified, Medicare will pay for you to receive hospice at a nursing home — but it won’t pay for you to live there. This is different from skilled nursing care, for which Medicare will help cover up to 100 days of a nursing home stay, after a three-day inpatient stay at a hospital.
Medicare typically won’t cover custodial care at a nursing home, if this is the only care you need, or nursing home boarding for people on hospice.
Figuring out how to fund hospice care at a nursing home can be challenging for some patients and discourage them from making the switch, Madden says.
It can be discouraging to the facility too. Madden explains that nursing homes do not receive the same Medicare reimbursements for hospice patients and custodial patients as they do for skilled nursing patients. So, while many nurses and doctors try their best to meet patients’ needs, money can influence how many hospice patients a facility will take at a time.
“There is a financial loss to the facility going from skilled to custodial,” Madden says. “They get paid more for skilled, so there can be more resistance to converting them.”
How to pay for hospice care in a nursing home
The good news is that you’re not on your own completely, and there are other ways to pay for hospice care at a nursing home.
Some payment options include:
— Your state’s Medicaid program
— Private insurance
— Veterans Affairs benefits
If you are transitioning from custodial care, you may be met with less resistance on the financial side — and may even have your payment plan already sorted out.
Additionally, depending on your health status when transitioning to hospice, and if you qualify for an inpatient level of care, your hospice program may also be able to help subsidize the cost of room and board at your nursing home, Madden says.
This could occur in examples when someone needs a bedside nurse to provide medication, or is being treated intermittently around the clock, he adds.
What to Do If You Can’t Receive Hospice at a Nursing Home
If you’ve figured out your finances and can afford hospice at a nursing home, take some time to congratulate yourself, because that’s a huge part of the battle. However, just because you can pay for the service doesn’t mean you can get it right away. Some nursing homes have limited space for hospice patients and may have fewer hospice beds than they do beds for skilled nursing patients.
If you can’t receive hospice care at a nursing home — for financial reasons, spatial reasons or other — there are other ways you can get care. If you have a home to return to or loved ones to host you, you could receive hospice care at home. You could also consider a board and care home, a lower level residential facility for older adults that can be more economically friendly.
Ultimately, Madden says that the decision to receive hospice care in or out of a nursing home should come down to what’s reasonable and comfortable for you.
“It’s a big deal right where you live and who’s seeing you,” Madden says. “You can’t let perfect become the enemy of what’s feasible.”
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How to Pay for Nursing Homes With Hospice Care originally appeared on usnews.com
