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End-of- Life Care

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The Medicare Incentive

When it comes to the subject of how and where we spend our final days, there is a lot of confusion and anxiety.  Where will I be able to get the care I need?  Will I be able to afford it?  What will be the best setting for what I need?  Your Denver nursing home attorney knows that in many cases, seniors are not receiving end-of-life care that meets their needs or their wishes.  One study found that roughly one in eleven seniors died in skilled nursing facilities.  Terminally ill patients are receiving end-of-life care at these facilities even though that is not what they are designed to give and most patients would rather spend their final days at home.  Why, then, are skilled nursing facilities providing end-of-life care?

While Medicare offers benefits for both skilled nursing facilities and hospice, reimbursement for the latter does not include living accommodations or coverage for round-the-clock care.  If a patient requires constant supervision and care, and family members or volunteers are not able or willing to work with paid staff, a skilled nursing facility may be the only option.  In fact, a patient who received care in a skilled nursing facility and received the Medicare skilled nursing benefit was more likely to die in a nursing home or hospital rather than at home, where a majority of seniors expressed they would prefer to die.

Hospice Care v. Palliative Care

Another issue complicating end-of-life care is the confusion between palliative care and hospice care, and in what setting each of these is most appropriate.  Hospice care should be administered in the home, and relies on family caregivers and a visiting hospice nurse.  To be eligible for benefits and hospice programs, a patient must be terminal or within six months of death.  Palliative care, on the other hand, is normally administered in a hospital or extended care facility.  A team of doctors, nurses, and professional medical caregivers provide comprehensive “comfort care,” treating pain, nausea, migraines, and other symptoms that can accompany illnesses and treatments for illnesses.  There are no time restrictions placed on this care; patients can be eligible for palliative care at any stage of illness, and can receive care whether the illness is terminal or not.

The difference between the two types of care is important because it dictates a different setting for the delivery of the care.  Although hospice care includes elements of palliative care, it is a distinct form of caregiving that is reserved for end-of-life patients.

What Can Be Done?

Some experts have suggested blending the skilled nursing facility benefit and the hospice care benefit to produce some sort of hybrid benefit in which a skilled nursing stay can accommodate hospice care.  This, however, would not allow people to spend their final days at home.  For that, hospice benefits would have to cover more hours of care, or partner with community programs that could fill in the gaps.

If you are in Denver or elsewhere in Colorado, and would like more information on end-of-life care, contact Jordan Levine at the Levine Law Firm.