Hospice vs. Nursing Home: What’s the Difference?
Understanding the difference between hospice and nursing facility care—and how the two can work together—can help patients and families make the best decisions when curative care is no longer preferred or possible.
Hospice can be provided to long-stay residents within the nursing facility if a physician has determined the resident likely has six months or less to live.
Understanding the difference between hospice and nursing home care—and how the two can work together—can help patients and families make the best decisions when curative care is no longer preferred or possible.
Nursing Facility Basics
Nursing facilities employ full-time clinicians or medical staff, as well as nursing and support staff. Residents may be temporary, in “rehab” as they prepare to return to their residential home, or they may be chronically ill and require 24-hour care/support. Nursing facility residents are either short-stay (100 days or fewer) or long-stay (101 days or more), depending upon the number of days they have resided in the facility.
- Hospitalized for at least 3 days prior to placement in a nursing facility
- Require “skilled” care (care that can be provided only by a nurse) for up to 100 days
- Elect to receive care through their Medicare Part A Skilled Nursing Home Benefit
- No pre-hospitalization required
- Have received nursing facility care for 101 days or more
- Unlikely to be able to live independently
- Eligible to receive care under the Medicare Part A Hospice Benefit
Do All Nursing Facilities Provide Hospice Care?
Hospice services are provided within some nursing facilities. The hospice mission is to care for people in the last six months of life, so hospice providers form relationships with nursing facilities to care for their hospice-appropriate residents.
In order to provide hospice services within the nursing facility, both the hospice provider and the nursing facility must have a written agreement that outlines the responsibilities of each. It is the decision of the administrator as to whether contracts are signed with one or more hospice providers.
Upon admission, residents/family considering a nursing facility placement are informed and periodically updated on which hospice providers are under contract for that facility. If a nursing facility has no contractual agreement with a hospice provider and the family chooses to relocate their terminally ill loved one, the nursing facility staff must assist the family in finding an appropriate facility.
What Factors Influence the Medicare Hospice Benefit vs. Medicare Nursing Home Benefit Decision?
If a terminal illness is the reason for admission to a skilled nursing facility (SNF), the patient cannot elect both the Medicare skilled nursing home benefit and the Medicare hospice benefit simultaneously. They must choose one or the other.
Who Pays for Hospice Care in a Nursing Facility?
All hospice services are covered by the Medicare hospice benefit and the Medicaid hospice benefit (Medi-Cal in California) for beneficiaries. Both provide the same levels of hospice care.
What Does Hospice Care for a Nursing Home Resident Look Like?
When a resident receives hospice services, the members of the nursing facility staff continue to furnish room and board and meet the resident’s day-to-day personal care and nursing needs. The hospice staff provide comfort care, symptom and pain management, spiritual and psychosocial support, and services that support quality of life at the end of life. Bereavement services are made available by the hospice to family, residents and nursing facility staff, all of whom may be coping with loss after the death.
Can the Resident's Physican be Involved in Hospice Care?
Yes. Just as in a home setting, the hospice physician and the patient’s physician communicate, establishing a plan of care (POC) with input from the nursing facility staff, family and resident.
What a Hospice Provider Should Do for the Resident:
- Provide all care related to the terminal illness
- Address the physical, emotional and spiritual needs of the resident and their family
- Improve family satisfaction with the personal touch and attention to detail that hospice services provide
- Consult with the resident/family/responsible party to be sure the plan of care reflects the resident's preferences
- Have difficult conversations about medical treatment decisions
- Assist with advance directives and funeral planning
- Avoid unnecessary hospitalization. When a medical crisis would ordinarily require hospitalization, hospice can provide shifts of continuous care in the nursing facility to enable the resident to remain comfortably in their own room
- Provide all resources related to the terminal illness, including medications, supplies and durable medical equipment
- Assure comfort, dignity and privacy; there should be no outward signs that a nursing facility resident is receiving hospice services
What a Hospice Provider Should Do for the Nursing Home:
- Partner with the MDS coordinators (MDS, or Minimum Data Set, is a federally mandated assessment process for nursing facility residents) to address identified areas requiring care (CAA, or care area assessment)
- Offer pre-survey assistance to ensure that documentation is current for residents receiving hospice
- Offer on-site assistance to communicate with surveyors and explain how the hospice interacts with staff
- Offer a coordinated plan of care that reflects how the hospice and nursing facility staff address the resident's needs
- Offer informed consent for palliative care, signed by the resident or their healthcare surrogate, for the resident to elect the Medicare hospice benefit
- Provide a statement, signed by a physician, indicating the resident has a terminal condition with a six-month prognosis if the disease runs its normal course. If the resident lives beyond the six-month period, care will extend as long as the resident continues to be hospice appropriate. Documents are incorporated into the nursing facility record, forming the basis for providing palliative, rather than curative, care.
- Provide ongoing training for nursing facility staff on the role of hospice and palliative care. The nursing facility staff provide training for the hospice team in meeting facility expectations
- Assist in protecting patient privacy and comply with HIPAA regulations, and guidelines for ethical issues that may accompany the election of hospice
Hospice and the Nursing Facility: An Optimal Experience
Utilizing hospice services in a nursing facility can result in an optimal experience for the resident and the family. Nursing facility staff are geriatric specialists, while members of the hospice team are end-of-life specialists. Their combined expertise can result in improved outcomes as the resident and family cope with the dying process.
Since 1978, VITAS has been helping people with life-limiting illnesses spend their last months at home in comfort. For more and more and people, that home is a nursing facility.