Question: Why not just use a nursing home for end-of-life care?

Answer: Well, many people are doing exactly that. Our experience, however, has been that nursing homes are far less than ideal places to receive end-of-life care.

The professional literature confirms our experience. In the November 2004 issue of Clinics in Geriatric Medicine, Doctors Susan Miller, Joan Teno and Vincent Mor reviewed the challenges to providing high-quality palliative care to dying nursing home residents.

In their article “Hospice and palliative care in nursing homes,” the authors expressed their concern about:

  • “The disturbingly high prevalence of unrelieved pain in nursing home residents . . . .”
  • Physicians being viewed by families as “missing in action” in nursing homes.
  • Nursing home staff shortages, high staff turnover and inadequate reimbursement.
  • Nursing home regulations and reimbursement focusing on restoration and rehab — not palliative or end-of-life care.
  • Medicare reimbursement rules creating disincentives to selecting hospice care in a nursing home (and giving up Medicare nursing home coverage).
  • Barriers to collaboration discouraging nursing homes and hospice providers from collaborating — different goals of care, differences in training, etc.

Much of the problem with nursing home end-of-life care appears to arise from nursing home focus — on restoration, rehab and reimbursement.