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Medical Matters: Hospice Care in the Nursing Home

  • Category: Patient Stories
  • Posted On:
  • Written By: Dr. Eric Bush, MD, Rph, MBA, Medical Director, Hospice & Palliative Care

When a patient has a life expectancy of six months or less, hospice care in the nursing home is covered by Medicare Part A. However, there are several hurdles to accessing this care. Taking a look at several examples will help to illustrate these potential issues.

Contract for Hospice Care

After Mrs. Oliver* broke her hip, she was released from the hospital to a nursing home for physical therapy five days a week. While she was receiving the physical therapy, her physician diagnosed her with terminal liver cancer, and certified that her life expectancy was six months or less. Although Mrs. Oliver’s hospice care was covered under Medicare Part A, in order to receive that care, the nursing home in which she resided needed to have a contract in place with a hospice provider. At this time, there is no legal requirement that nursing homes contract with hospice providers. Therefore, even though Mrs. Oliver was dying of liver cancer, if her nursing home had not had a contract with a hospice agency for the provision of hospice care, she would not have been able to receive Medicare-covered hospice care.

Room and Board

Another significant barrier to receiving hospice care while residing in a nursing home is the fact that the Medicare hospice benefit does not pay for room and board. For instance, Mr. Hollande* is receiving daily skilled nursing care in the nursing home for his terminal heart condition, so Medicare Part A pays for both his medical care and his room and board. However, if he were to elect the Medicare hospice benefit, Medicare would pay for hospice care, but not for his room and board—a cost that can top $8,000 per month.

When is Hospice Care in the Nursing Home Covered?

Mrs. Marshall* lives in a local nursing home with which Hospice of Frederick County has a contract for provision of care. She qualifies for both Medicare-covered hospice care and Medicare-covered room and board. This is due to the fact that she has two diagnoses: a broken hip which qualifies her for Medicare skilled nursing facility coverage, and terminal pancreatic cancer which qualifies her for hospice coverage. As long as Mrs. Marshall continues to receive physical therapy five days per week, Medicare will cover her physical therapy, her hospice care, and her room and board. Unfortunately, once her physical therapy ends, even though she will continue to be eligible for Medicare covered hospice care, Medicare will no longer cover Mrs. Marshall’s room and board.

Hospice of Frederick County feels privileged to provide expertise in end-of-life care to the patients we serve in nursing homes. If you have a loved one in a nursing home or other facility and feel they could benefit from Hospice of Frederick County services, please contact us today.

*Names changed to protect patient privacy.