Hospice Care in the Nursing Home

At least one in four Americans dies in a nursing home, and evidence indicates that many nursing home residents receive suboptimal end-of-life care. Approximately 25% of residents with daily cancer pain receive no pain medications, and residents are often transferred to an acute care setting to receive aggressive treatment in the last weeks of life. In the nursing home, hospice care can provide end-of-life comfort care for residents with such disorders as advanced dementia, heart failure, and cancer.

What is the difference between palliative care and hospice care?

Hospice care involves the overall support and care for the dying person. Palliative care involves managing specific problems such as pain, nausea, vomiting, and diarrhea. Palliative care is also called “comfort care.”

Can hospice care be provided at the nursing home?

Hospice is a mandated benefit for all residents with Medicare and VA coverage, and to most residents with Medicaid or private insurance, so nursing homes should be offering this service. Most nursing homes provide hospice services by contracting with community hospice programs.

What are the advantages of hospice care in the nursing home?

Hospice care has been associated with better pain management and lower rates of inappropriate medication and physical restraint use. Families also perceive that hospice improves nursing home end-of-life care. Part of the reason that these outcomes are noted is that hospice agencies have additional nursing staff, social service staff, and a chaplain that provides additional services and support above and beyond the services provided by the nursing home. Hospice care includes care for physical, psychological, emotional, and spiritual needs. Hospice staff also can serve as an extra set of “eyes and ears” if you are concerned about the quality of end-of-life care your loved one is receiving in the nursing home.

Are all hospice agencies alike?

No, hospice agencies are not all alike. Not every hospice agency is adequately prepared to care for nursing home residents or to contract with a nursing home to provide care. Some are more focused on cancer care and are not trained or prepared to manage the unique needs of nursing home residents with end-of-life conditions that involve multiple nonmalignant conditions and behavioral issues of dementia. Nursing homes are responsible to contract with hospice agencies that can meet the unique needs of nursing home residents.

What is the process to have my loved one in the nursing home evaluated for hospice services?

The physician will evaluate whether your loved one meets specified criteria for hospice care. If criteria are met, then the physician, nurse or social service staff will contact you to discuss your choice for a hospice agency. If you have no preference, the facility may have one. If you have a preference, you have the right to use the provider you would like.
The nursing home is responsible for working with the hospice agency to coordinate care for your loved one and notifying the hospice agency if your loved one has a change in condition. You may terminate hospice services at any time, or hospice may be terminated if your loved one’s condition improves, and he or she no longer qualifies for hospice services.


AMDA: Governance - Resolutions and Position Statements - Access to High Quality End-of-Life Care in Nursing Homes

Clinical Practice Guidelines for Quality Palliative Care. National Consensus Project
for Quality Palliative Care.

Teno J. The Brown atlas of dying in the United States: 1997-2001.

Zerzan, J., Stearns, S., & Hanson, L. (2000). Access to palliative care and hospice in nursing homes. Journal of the American Medical Directors Association, 284(19), 2489-2494.