Opportunity may be knocking, but many operators don't want to answer the door

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John O'Connor
John O'Connor

If you are a long-term care operator, the latest report from the National Hospice and Palliative Care Organization should leave you with mixed feelings.

On the one hand, the annual update finds that the percentage of hospice patients receiving end-of-life care in a nursing home increased from 17.2% in 2012 to 17.9% last year.

On the other hand, it's hard to believe these numbers are still so incredibly low.

In the interest of full disclosure, I've had a family member receive hospice services, so my view has been colored by experience. That's especially the case given the incredibly sensitive, attentive and compassionate care that my mother received in her final days, thanks to hospice. So I'm not objective on this matter.

But to paraphrase Bob Dylan, you don't need to be a weatherman to know which way the wind is blowing. And given the changing resident profiles we're seeing among so many skilled care patients — many suffer from cancer, dementia, heart disease, lung disease, stroke, liver disease and other life-shortening conditions — skilled care and hospice care should go together like Marco and Polo.

Speaking clinically, long-term care settings are ideally suited to deliver kinds of care and compassion usually associated with hospice services. Speaking financially, Medicare is far and away the primary payer for hospice care. Need I say more?

Yet, most hospices are independent, freestanding agencies (58.3%). Only 5.1% are part of a nursing home, according to the report. How late are nursing homes to the dance? Nearly one in five hospice agencies are part of a hospital system (19.8%), while 16.7% are part of a home health agency. Any way you slice it, skilled care is a laggard here.

To recap: Skilled care operators are ideally suited to deliver more hospice care. The service is eligible for top-shelf Medicare funding And by the way, there is a growing need for this service.

So it's probably more than fair to ask whether nursing homes should play a larger role in delivering hospice care. But a better question is this: What's taking so long?

John O'Connor is McKnight's Editorial Director.

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Daily Editors' Notes

McKnight's Daily Editors' Notes features commentary on the latest in long-term care news and issues. Entries are written by Editorial Director John O'Connor, Editor James M. Berklan, Senior Editor Elizabeth Newman and Staff Writer Marty Stempniak.

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