Hospice Care in Nursing Facilities & Assisted Living Facilities

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Hospice care is provided wherever a patient calls home. Approximately 35% of all hospice care in America is provided in nursing facilities (nursing homes). It is estimated that another 10% of hospice care is provided in assisted living facilities.

  • On a given day, 1.6 million Americans are in a nursing facility
  • Nearly one in two persons who lives into their 80s will spend time in a nursing facility prior to death
  • Federal policy has resulted in shorter hospital stays and increased use of nursing facilities
  • In 2001, 49.2% of Americans died in an acute care hospital; 23.2% died in a nursing facility
  • By 2020, it has been estimated that 40% of Americans will die in a nursing facility

Added Value of Hospice in Nursing Facilities & Assisted Living Facilities

  • Reinterprets rehabilitative goals into palliative care goals
  • Aggressively treats uncomfortable symptoms
  • Care team assists Facility, resident and family in identifying realistic short and long term goals
  • Supports Facility in helping physicians understand resident self- determination and informed consent
  • Residents and families receive time from the hospice care team for working on psychosocial and spiritual issues
  • Helps maintain residents “at home” in the facility during dying process
  • Allows the Facility to market a “continuum of care”
  • Supplies care and support with greater presence than nursing facility staffing patterns allow
  • Resident families and Facility staff are supported with bereavement services after the death of the resident
  • Hospice helps ensure discussion of end-of-life issues
  • Helps assure proper documentation and execution of DNR orders according to resident’s wishes
  • Works with families to plan funerals to alleviate stress at time of death

U.S. Department of Health & Human Services Study

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In order to learn more about the use of the hospice benefit in nursing facilities and outcomes of care, the U.S. Department of Health & Human Services undertook a major study of the issue entitled, “Synthesis and Analysis of Medicare's Hospice Benefit”. This study documented for the first time important benefits to the resident and the nursing facility resulting from successful collaboration between hospice providers and nursing facility providers.

Specifically, the study found that residents in nursing facilities receiving hospice care, as compared to residents in nursing facilities not receiving hospice care:

  • Received superior pain assessments, and when daily pain was assessed, were far more likely to be treated
  • Received fewer invasive procedures, such as physical restraints, parenteral or intravenous feedings, and intravenous and intramuscular medications
  • Experienced less dyspnea or shortness of breath

The findings regarding reduced acute care admissions prior to death are impressive because of the quality of care and cost saving implications. The table below shows the percent of patients with acute hospital stay immediately prior to death.

Percent of Patients with Acute Hospital Stay Prior to Death

Days Before Death
Hospice Enrolled
Not Hospice Enrolled
  Last 30 days of life
12%
41%
  Last 90 days of life
24%
53%
  Last 180 days of life
40%
62%

These findings support our view that residents in nursing facilities receiving hospice care experience a higher quality of life at the end of life.

There are many ways in which nursing facilities can provide high-quality end-of-life care that is consistent with residents' wishes. Successful approaches can include developing a facility statement regarding end-of-life philosophy; using palliative care protocols that define appropriate pain management; and documenting the goals and wishes of a resident at the end of life. Offering hospice care, when appropriate, is also a strategy that reflects a facility's commitment to these goals.

When a nursing facility enters into a contract with a hospice provider, many different types of benefits will accrue. The hospice interdisciplinary staff is available as a resource to facility staff, at the same time they are providing care to the resident.

On a day-to-day basis, the hospice will:

  • Assist staff in managing physical symptoms that are not under control
  • Provide additional staffing to help resolve complex issues requiring palliative care expertise
  • Assist staff in managing the psychosocial issues of both the resident and family
  • Provide supporting documentation of high-quality and appropriate care for the dying resident