Hospice in the Nursing Home

Last Modified: December 12, 2013

Hospice care is recognized as a specialized modality of care for the terminally ill. It is not a place, but a philosophy of care. Hospice care can take place in a home, a hospital or a long term care facility, such as a nursing home. Over the past few decades, with the resurgence of home-based care, patients and families are choosing to remain in the familiar surrounding near to loved ones who provide care and comfort. However, many of those eligible for hospice care reside in nursing homes or long term care facilities.

Hospice agencies provide services to residents of long term care facilities when that facility is considered the patient's home residence. The hospice and the nursing facility agree upon a coordinated plan of care that reflects the hospice philosophy of enhancing quality of life thorough expert pain and symptom management.

Hospice care provides an interdisciplinary team approach to support and enhance end-of-life care provided in the nursing facility. The team works closely with the patient's own physician. Hospice teams consist of a medical director, registered nurse, social worker, chaplain, volunteer, home health aide, pharmacist, and if needed, therapists. All aspects of care related to the hospice diagnosis are covered by insurance, including:

  • Skilled services
  • Medications related to the terminal diagnosis
  • Durable medical equipment and most supplies related to the terminal diagnosis.

The facility staff is in a unique role of functioning as the patient's own extended family and also as a member of the hospice team. Bereavement support is typically offered to the family and staff who cared for the patient, after the patient's death.

Eligibility requirements for residents of a nursing facility are the same as for patients living in their own home who desire a focus on comfort and palliation of symptoms rather than curative approaches. If eligible, services are financed under Medicare Part A, Medicaid, or private insurance. Patients residing in a skilled nursing facility using their Medicare Part A Skilled Nursing Facility (SNF) benefit are not eligible for both SNF coverage and hospice. Patients and their families must choose which of the Medicare Part A benefits will be of most value.