Critics of nursing-home hospices suspicious of revenue

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People with dementia more likely to die at home than a facility
People with dementia more likely to die at home than a facility

When a major lobbying group trumpeted the long-term care industry's status as an economic and job-creating powerhouse last week, critics took the opportunity to press for further inquiries into how nursing homes are financed and operated — particularly LTC facilities that provide hospice services.

Medicare spending on hospice tripled between 2000 and 2007, noted a new Politico article on the subject late last week. Upon learning these numbers, the Medicare Payment Advisory Commission requested an investigation into the relationship between hospices and long-term care. In 2009, the Centers for Medicare & Medicaid Services began performing random audits of nursing homes with hospice services. Critics say the system needs to be reformed so that hospice patients can receive care in their own homes. They also pointedly note that while flat-rate Medicare might pay a nursing home $110 to $130 per day, the rate soars by an additional $130 per day if a resident becomes a hospice patient at the same site.

Providers argue that many hospice patients don't have homes or caregivers to return home for palliative care. One CMS spokesperson countered that statement by pointing out that nursing home hospice residents are relatively easier to take care of because they require less care and request fewer nursing and aide services than hospice patients who live at home.