B. Wiebe It or Not
Medical Director’s Newsletter

Family Hospice in Nursing Facilities

I am often asked, “What is the purpose of hospice care for nursing home residents? Don’t residents in nursing homes get all the care they need? What extra benefit does hospice care afford nursing home residents?”

Here are some background facts:

• 1 in 3 residents admitted to nursing homes die within a year.
• The percentage of Americans dying in nursing homes is increasing: 28% in 1997 and rising. A Brown University study estimates that by 2020, 40% of American deaths will take place in nursing homes.
• The percentage of dying nursing home residents receiving hospice care has increased from 11% in 1992 to 36% in 2000. And the trend continues.
• The percentage of nursing homes offering hospice care has increased from 30% in 1997 to 76% in 2000.

So why? Why hospice care in Nursing Homes?

When the health of nursing home residents is frail and the goal for care is comfort, the hospice team can assist the nursing facility to better honor nursing home residents’ wishes. Nursing home staff is more prepared to avoid initiating diagnostic and treatment interventions when their residents are on hospice. This occurs because the goals of care are more clearly understood, and because having residents on hospice reduces the regulatory imperative to “do something” when a new development arises with a resident’s health status. Remember, nursing homes are under a great deal of pressure to comply with regulations (whether compliance is always in the best interest of the patient or not).

Hospice enrollment results in better symptom management. In contrast to aggressive, curative care, hospice offers nursing home residents aggressive palliative care with attention to physical, emotional, and spiritual suffering. Research shows that an alarmingly high percentage of nursing home residents are in persistent pain, to say nothing of under-managed, non-pain symptoms. With a multi-disciplinary team approach and strong orientation to symptom management, hospice is well positioned to support nursing homes in achieving palliation of symptoms at the end of life.

Hospice care in the nursing home is associated with lower hospitalization rates, as has also been observed in home-based hospice patients. (Non-hospice patients in nursing homes where there is a hospice presence have also been found to be less likely to be hospitalized.) The reduced hospitalization rate means that frail nursing home residents will be less likely to receive diagnostic and treatment interventions, which are not appropriate in relation to their goals of care, and which carry potential morbidity for them. Additionally, hospitalizations represent the major component of health care costs, especially in the last few months of life. A Florida study in 2004 showed that hospital expenditures accounted for 78% of all expenditures in the last month of life in patients not receiving hospice care, and 33% among nursing home residents who had hospice care in the last month of life. We spend a lot of money on diagnostic tests and curative treatment when patients are actually dying!

Again, hospice care offers nursing home residents better odds of honoring patients’ wishes, more effective management of symptoms, and reduction of hospitalizations. Hospice care in nursing homes offers other benefits, as well: The cost of medications used in achieving symptom control for the terminal diagnosis is covered by hospice. Helpful equipment like special beds and mattresses for skin protection are provided through the hospice. Bereavement services are offered up to a 13-month period following death, extending hospice’s supportive role beyond the patient’s death.

Family Hospice enjoys good working relationships with numerous nursing homes in the area. At the time of writing, we help to support 31 different patients in 10 different nursing homes, representing 36% of our case load, and with 16 different terminal diagnoses.

We are pleased to assess any area nursing home residents for eligibility for hospice care. Think “goals of care.” What are the wishes of your patients or their health care representatives for ongoing treatment? A shift to comfort care and hospice services does not mean the end of aggressive treatment – only the end of aggressive ‘curative’ care. Nursing home residents enrolled in hospice benefit from renewed focus on the provision of aggressive ‘palliative’ care.

If we think hospice for our end-of-life nursing home patients/residents, we’ll ensure better and more appropriate end-of-life care.

Bwiebe it or not!
Bernie Wiebe, MD Medical Director, Family Hospice of NE Indiana

Other Newsletters

2007-Quarter 1 Newsletter  

2007-Quarter 2 Newsletter 

2007-Quarter 3 Newsletter 

2007-Quarter 4 Newsletter