Medicare policy driving longer nursing home hospice stays

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Researchers question end-of-life practices at nursing homes
Researchers question end-of-life practices at nursing homes

The length of Medicare-certified hospice stays in nursing homes has doubled over the last decade, according to a new report from Brown University.

Between 1999 and 2006, the average length of a hospice stay in a nursing home rose from 46 days to 93 days, researchers found. At the same time, researchers noted a 50% increase in the number of hospices, most of which are for-profit. The report's authors suggest that Medicare's policy of paying a standard daily rate for most Medicare hospice care could be behind the increase in the number of providers, which in turn drives longer hospice stays.

The overall increase in the availability and use of Medicare-sponsored hospice services is a positive development, the researchers say, while the longer lengths of stay raise certain policy concerns. Still, they caution against sweeping changes to the system, recommending instead a tiered system with higher reimbursements at the beginning and end of hospice care. The study is slated to appear in the August issue of The Journal of the American Geriatrics Society.