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Nursing Home Residents Often Receiving Inadequate Care

Nearly one-third of Medicare beneficiaries use the program to pay for the last six months of life while in nursing homes, even though most facilities are not properly equipped for comfort or treatment, according to a new study published in the Archives of Internal Medicine.

According to lead researcher Katherine Aragon, M.D., of the University of California at San Francisco, nursing homes should be reconsidered as a first choice for end of life care. “Often our focus on these patients is trying to keep them functional or independent for as long as we can. What we may be overlooking is that they are on an end-of-life trajectory,” Aragon says.

Nursing homes are designed for rehabilitation and long-term care. Nursing homes differ from hospice or palliative care centers, which focus on comfort care for those facing imminent death. According to the study, “In the last 6 months of life, many older adults will experience a hospitalization, followed by a transfer to a skilled nursing facility (SNF) for additional care.”

The researchers conclude that there is a lack of understanding about who actually uses nursing homes. “Our finding that Medicare decedents commonly used SNF (skilled nursing facilities) care at the end of life suggests a need to better understand who is using the SNF benefit and whether they are receiving care that matches their goals,” according to science and technology website RedOrbit.

The federal health insurance program Medicare is for seniors and the disabled. It only pays for 100 days of skilled nursing facility care after a person is hospitalized for at least three days, Reuters reports. “Under those benefits, the program pays 100 percent of the bill for the first 20 days of care, and all but a $144.50 per day copayment after that.”

The study analyzed more than five thousand people between 1994 and 2007. Thirty-one percent of beneficiaries used nursing home benefits in the last six months of life, and 9 percent died while using homes at the average age of 83.

Study researchers conclude that palliative care should be incorporated into nursing home care.

Reuters spoke with Dr. Peter Boling, a professor of geriatric medicine at Virginia Commonwealth University Medical Center. “It ends up being all about the money in the end, which is always the case,” Boling says. He asserts that it would require legislative or regulatory action to reimburse homes for palliative services.

The study’s researchers also encouraged commentary from Boling who writes: “Reflecting on this study, about half of the SNF users did not die in the nursing home and ultimately went home, despite having significant frailty. We must all carefully avoid rushing to judgment and imposing end-of-life care protocols when reasonable vitality and quality of life remain, despite chronic illness burden.”