The effectiveness of hospice in nursing homes is debated by the medical community, but the benefits of these arrangements are undeniable. Fewer than 9 percent of nursing homes have a hospice component, but this percentage has risen steadily. Some benefits include improved pain management and supportive care. Others are questionable, but many of these considerations are well worth investigating. This article explores these issues. Also, it outlines the benefits and risks of incorporating hospice into nursing homes.
A growing trend is the common ownership of nursing homes and hospice agencies. This is consistent with the overall trend of consolidation in the health care industry, and may result in improved access to end-of-life care. This move could also improve coordination among nursing homes and hospice providers, and increase the length of stay for hospice patients. The two sectors share per-diem reimbursements for the care of the same residents. A common ownership model may improve the quality and availability of hospice care, and also reduce the cost of care for seniors.
Among the nursing homes studied, less than 9 percent had hospice services on any given day. While the percentage of hospice visits in common-owned facilities was higher, they had fewer patient-centered services. In addition, common-owned nursing homes experienced fewer hours of visits per day and a lower percentage of days with any kind of visit. However, these differences may not be caused by the number of hospice visits per day, but by the fact that they belong to a common hospice agency.
While the number of common-owned hospice agencies has increased over the years, their numbers are still relatively low compared with non-chain providers. This is partly due to the growing role of chain agencies, which include for-profit and nonprofit organizations. In 2015, nearly 20% of all Medicare hospice enrollees were served by a common-owned agency, up from 6% in 2005. It is unclear what the reasons for this disparity are, but it is important to note that common-owned nursing homes are not exclusively owned by hospice agencies.
This study shows that state-level differences in the proportion of hospices that are owned by nursing homes are associated with lower rates of common-ownership. In addition, the percentage of nursing homes owned by hospice agencies was highest in the Southeast and Northern Plains states. The lowest percentages were found in the Midwest and Northeast. This finding suggests that common ownership between hospices and nursing homes may be an indication of poor coordination of care.
The state’s Department of Health and Human Services (HHS) recently released a report revealing a staggering increase in deaths from infections and staph. Many of these facilities did not adhere to state-mandated infection-control policies, including screening employees and isolating patients with staph infections. The scandal has not only been a source of agony for nursing home residents, but also a political liability for the Cuomo administration. When the report was published on March 25, the Cuomo administration pushed back against accusations that his administration had not done enough to keep residents safe.
The rise in on-site deaths in nursing homes is particularly alarming. The rise in infection rates could be linked to a number of factors, including inadequate staffing levels and lack of personal protective equipment. The outbreak of the Coronavirus, or H5N1, in nursing homes began around June 2009 and spread quickly among at-risk residents and the elderly. The outbreak was so severe that by mid-July, 51,000 residents of nursing homes had died, accounting for one-quarter of the nation’s death toll.
Private equity investors have also made it a point to cut staff at some nursing homes. They did so because it gave them a higher rate for every three-day stay in a hospital. The private equity firms often exploit the inefficiencies in the payment system by transferring patients from nursing homes to other facilities, which could result in lapses in care and medical errors. This is an unacceptable trend. A new study has highlighted the problem and suggests a way forward.
The CDC reported that COVID-19 deaths in long-term care facilities accounted for 40 percent of the nation’s total death toll from this infection. Although this number is significantly higher than the numbers reported by the federal government, the analysis found that the deaths were not uniform across facilities. The findings also show that there are significant gaps in data available for assessing the impact of individual patient characteristics. This report highlights the importance of comprehensive, timely data to monitor the COVID-19 epidemic.
Increasing access to care with hospice in a nursing home can help residents with cancer manage their pain. Although many of these patients are not able to communicate their pain, they may try to hide it, fearing that it will make them seem weak. In this case, family caregivers should keep a close eye on them and be aware of any changes in behavior that may indicate pain. If they detect any changes, the staff can initiate a multimodal approach to pain management.
In addition to providing pain medication to a patient, end-of-life care should also include minimizing interruptions and allowing the patient adequate rest periods. If this is not possible, care providers should cluster the patient’s care around the time of administering pain medication. Lastly, caregivers should make sure that patients and families understand the goal of pain management. The team should also create a supportive environment for the patient and their family members to talk about their wishes and concerns.
The difference between patients who receive hospice care and non-hospice residents was dramatic. Pain was reported by 63.7% of hospice patients compared to 44.4% in non-hospice residents, with the former reporting more frequent pain and the latter experiencing less intense pain. Further, the hospice residents were older, and more likely to have been diagnosed with dementia. Additionally, they were less likely to be married and have a significant change in their status MDS assessment than non-hospice patients.
One study in a nursing home explored the reasons people choose to end their lives. One reason was the pain of not mattering. Other factors involved the use of opioids in pain management. These factors make it difficult for nurses to assess the patient’s pain with a proper analgesic regimen. Nurses should also consider the presence of relatives, particularly those with advanced dementia. A grandchild can often identify signs of pain, which can alert nursing staff to a potential problem.
In addition to medication for acute pain, hospice care can help with emotional pain, such as depression. Hospice nurses can prescribe Valium or Ativan for patients who experience anxiety. Visiting a chaplain or social worker may also help in pain management. Hospice care is particularly useful in the initial transition, as the staff are trained and familiar with treating patients who are not used to receiving pain management. It is also important not to add additional stress to the patient by attempting to comfort them.
The process of supportive care in a nursing home involves a variety of activities designed to help residents cope with their illness. These activities may include evaluations by a physician or nurse practitioner, counseling and social services visits, and treatment and guidance for the resident’s daily challenges. In some cases, the program can even include the administration of medications. In addition, the programs provide relief from discomforts like constipation, loss of appetite, and nausea. As a result, residents can better tolerate their medical treatments and face the challenges of daily life.
Other types of supportive care programs focus on complementary and integrative medicine. The goal of these programs is to help patients manage multiple aspects of their health, such as pain, depression, and anxiety. There are many different approaches to supportive care, including music therapy. For example, ONS member Vivian Sarubbi, a charge nurse at Pacific Cancer Care and Community Hospital in Monterey, California, is a certified clinical musician who performs therapeutic music for patients at the facility.
Supportive care is sometimes referred to as palliative care. These services aim to help patients live as comfortably as possible during the last stages of their illness. It is available for patients of all ages and stages of their illness. Bassett Healthcare Network’s palliative care specialists can help with the transition from one form of care to another. These services may take place in a nursing home, hospital building, or clinic setting.
An important change in Medicare and Medicaid requirements is the requirement for on-site infection preventionists. CMS will now strengthen the requirement for on-site infection preventionists and increase the number of nursing home staff members. The changes will also undo changes made by the Trump Administration. As more natural disasters and pandemics threaten the health care system, proactive emergency preparedness is crucial for the health care industry. A well-maintained health care facility is vital to the overall health of its residents.