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Do seniors turn to the right places at end of life?

By Andrew M. Seaman

NEW YORK (Reuters Health) - A new study says almost one third of Medicare's beneficiaries use the program to pay for end-of-life care at nursing homes, which may not be equipped to treat or prevent pain and suffering.

Those palliative care services are usually associated with hospice care, while nursing homes are typically for rehabilitation and long-term care.

The study's researchers, who published their findings in the Archives of Internal Medicine on Monday, say the findings suggest that palliative or hospice care should be incorporated into Medicare's nursing home benefits.

"Often our focus on these patients is trying to keep them functional or independent for as long as we can. What we may be overlooking is that they are on an end-of-life trajectory," said Dr. Katherine Aragon, the study's lead author from Lawrence General Hospital in Massachusetts.

Medicare, the federal health insurance program for the elderly and disabled, pays for 100 days of skilled nursing facility care after a person is hospitalized for at least three days.

Under those benefits, the program pays 100 percent of the bill for the first 20 days of care, and all but a $144.50 per day copayment after that.

That may be less expensive for patients and their families than using Medicare's hospice benefits, which does not pay for room and board. Patients need to pay for that out of pocket, through additional insurance or Medicaid - for which many may not qualify.

For the study, Aragon and her colleagues at the University of California, San Francisco, gathered information from a database to see how many people - recently released from a hospital - used Medicare's nursing home benefits during the last six months of their lives.

After looking at information on more than 5,100 people between 1994 and 2007, the researchers found that about 31 percent had used the nursing home benefits in those last six months, and about nine percent died while still using those benefits.

The study, however, cannot say what type of care those patients received before their deaths. It also doesn't say how much those stays cost the Medicare program.

Aragon told Reuters Health that some nursing homes are offering palliative and hospice care, but she does not see the current situation changing without the homes being reimbursed for the care.

Dr. Peter Boling, from Virginia Commonwealth University in Richmond, told Reuters Health that it would most likely require legislative or regulatory action.

"It ends up being all about the money in the end, which is always the case," said Boling, who wrote a commentary accompanying the new study.

SOURCE: http://bit.ly/MbBLb9 Archives of Internal Medicine, online October 1, 2012.

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