Hospice services can be delivered in several different settings including hospital inpatient, home services, assisted-living facilities, and nursing homes. This entry in the Hospice Series will deal specifically with the ins and outs of arranging services for loved ones in long term care facilities.
More than half of my patients currently reside in nursing homes. A significant percentage of my home patients will end up in such facilities once their loved ones can no longer handle the “heavy lifting” of their care by themselves at home. Hospice can be extremely beneficial for patients in long term care for several reasons including the following:
- Once a patient is living in a nursing home, their Medicare benefits are no longer paying their room and board as Medicare will only do so for a fixed amount of time and only for patients that are receiving restorative or rehabilitative therapies. The great majority of hospice patients do not qualify for such treatments as they are unable to participate and make the significant gains required by Medicare for continued reimbursement. At this point room and board are either being covered by private pay, long term care insurance, or Medicaid (or some combination of these). This means that Medicare will cover hospice costs at 100% with no additional charge to patients or families.
- Hospice patients in nursing homes typically receive more person-to-person contact than other residents. Hospice nurses will usually make 2 one-hour visits per week as will hospice aides. Patients will also have a social worker and chaplain making regular visits as well as potential massage therapy and volunteer time. This is likely the reason why patients coming onto hospice service may become a little more social toward their own family members as they are forced into interpersonal interaction with more people. Hospice is participatory for patients and families and keeps them more engaged with one another.
- In any nursing home, whether it be the nicest five star facility or a notoriously undesirable one, the patients that receive the best care and the most attention from staff are typically the ones that have the most visitors. While this may seem not to make sense on the surface, facility staff are kept on their toes as there is more potential for hospice personnel to notice dereliction of duty by such staff. Simply put, hospice provides several extra sets of eyes for families and tends to communicate anything of concern directly to a patient’s family. Nursing home staff know this and act accordingly.
- Nursing homes are unfamiliar places and a patient’s adjustment to them can range from disruption of normal lifestyle to extreme paranoia and emotional discomfort. Hospice staff offer a modicum of consistency that can provide comfort for patients as they tend to look forward to seeing the same faces on a regular basis. Patients also feel more important and loved by the extra attention.
The bottom line is that, should you find yourself in the position that your loved one’s physician feels that hospice is the desired medical intervention, you can take some comfort in the aforementioned facts. Once these are adequately and tactfully explained to families, they come to see hospice in the nursing facility as what I call both a “win-win situation” and a “no-brainer”. Until next time.