Home Care & Hospice may be Less Costly

I recently came across news article touching on some relevant data concerning Medicare coverage. I have edited and summarized information gleaned from a research study conducted by Reuters Health. According to the researchers, data suggests that almost one third of Medicare’s beneficiaries use the program to pay for end-of-life care at nursing homes. Put another way, 30% of the seniors in this country, in end stage of life, are utilizing Medicare benefits. Knowing the expense of nursing homes, one can surmise that this is a huge expense for the Medicare system. In addition, the research indicates that many nursing homes may not be properly equipped to treat or prevent pain and suffering.

So is this money being well spent? Nursing homes are typically for rehabilitation and long-term care. Therefore, much of the funding assistance may not be addressing the elder population and their end of life needs.

The study’s researchers, who published their findings in the Archives of Internal Medicine on Monday, say the findings suggest that palliative or hospice care should be incorporated into Medicare’s nursing home benefits. Correct me if I’m wrong, but this “suggestion” would actually increase the overall expense to the Medicare system. The current dilemma faced by policymakers is to decrease costs. Not the opposite.

Medicare, the federal health insurance program for the elderly and disabled, pays for 100 days of skilled nursing facility care after a person is hospitalized for at least three days. Under those benefits, the program pays 100 percent of the bill for the first 20 days of care, and all but a $144.50 per day co-payment after that. That may be less expensive for patients and their families than using Medicare’s hospice benefits, which does not pay for room and board. Patients need to pay for that out of pocket, through additional insurance or Medicaid – for which many may not qualify.

So a significant portion of the elderly population uses Medicare for end-of-life benefits provided by nursing homes. As stated in previous columns, Medicare accounts for upwards of 20% of the entire gross national product (GNP) in the United States. But research indicates that elder consumers would actually be better suited for end-of -life hospice care. Unfortunately, hospice benefits through Medicare are more expensive – or an additional expense on top of care provided by nursing homes.

For the study, researchers at the University of California, San Francisco, gathered information from a database to see how many people – recently released from a hospital – used Medicare’s nursing home benefits during the last six months of their lives. Their findings indicated that about 31 percent had used the nursing home benefits in their last six months, and about nine percent died while still using those benefits.

The study, however, cannot say what type of care those patients received before their deaths. It also doesn’t say how much those stays cost the Medicare program. Researchers said that some nursing homes are offering palliative and hospice care, but that these facilities may not have been reimbursed for these care services. Others are not likely to follow without some form of reimbursement for additional elder services.

One option to the above confusion…provide hospice care (funded by Medicare) in combination with home care services.