Hospice care focuses on comfort and quality of life for individuals facing a terminal illness, shifting the priority from curing the disease to managing symptoms and providing psycho-social and spiritual support. A skilled nursing facility (nursing home) provides long-term, 24-hour custodial care. Patients residing in a nursing home who meet the medical criteria for end-of-life support can receive concurrent hospice services directly within the facility. This allows the patient to remain in their familiar environment while accessing specialized comfort care.
Delivering Hospice Services in a Nursing Home
Providing hospice care in a nursing home involves collaboration between the facility staff and the contracted hospice agency team. The nursing home staff maintains their role of providing custodial care, including room and board, meals, assistance with daily activities, and routine nursing oversight. This daily support remains under the direct management of the nursing home.
The hospice agency introduces an interdisciplinary team that supplements the existing care model with specialized end-of-life services. This team typically includes a hospice physician, registered nurses, social workers, spiritual counselors, and hospice aides. The hospice team visits the resident on a schedule tailored to their individual needs, which can range from a few times a week to daily visits during periods of increased symptoms.
The primary responsibility of the hospice team is managing pain and other symptoms related to the terminal diagnosis. They provide all necessary medical equipment and medications related to the terminal illness. Effective communication between the nursing home’s charge nurse and the hospice nurse coordinates the care plan and ensures seamless symptom management. The hospice team acts as a resource for facility staff, offering expertise in palliative care to optimize the resident’s comfort.
Qualifying for Hospice Care
To receive hospice services, a resident must meet specific medical requirements established by Medicare, which governs the benefit. The primary clinical requirement is that two physicians must certify the patient is terminally ill, meaning they have a prognosis of six months or less to live. This certification must be provided by the patient’s attending physician and the hospice agency’s medical director.
The patient, or their legally authorized representative, must also formally elect the hospice benefit, which includes an understanding that the focus of care is changing. By electing hospice, the patient waives their right to receive Medicare coverage for any curative treatments related to the terminal illness. The goal shifts entirely to comfort and symptom management, although care for conditions unrelated to the terminal diagnosis continues to be covered as usual.
If a patient lives longer than the initial six-month certification period, they do not lose the benefit. Hospice care is provided in distinct benefit periods: two 90-day periods, followed by an unlimited number of 60-day periods. Before each new period, a hospice physician must recertify that the patient continues to meet the eligibility criteria of a six-month or less prognosis. This ensures the patient receives continuous support as long as they remain medically eligible.
Covering the Costs of Dual Care
Understanding the financial structure of dual care is important because payment responsibilities are separated between the two services. The Medicare Hospice Benefit covers virtually all services related to the terminal illness, provided by the hospice agency, typically at no cost to the patient. This coverage includes visits from the interdisciplinary team, all medications for symptom control, and necessary medical equipment and supplies.
A crucial distinction is that the Medicare Hospice Benefit does not cover the cost of room and board in the nursing home. Room and board refers to the patient’s daily living expenses, such as their room, meals, and the routine custodial care provided by the facility staff. The patient or their family remains responsible for these costs, which are the same charges they were paying before hospice was elected.
If the patient is financially eligible, Medicaid may cover the room and board costs, as this program covers long-term custodial care for low-income individuals. If the patient is not Medicaid-eligible, the family or private funds are used to pay the daily rate charged by the nursing home. Medicare only covers short-term room and board charges if the hospice team orders temporary inpatient or respite care in the facility.