Should Medicare Update Nursing Home Benefits to Incorporate Hospice Care?

Medicare’s skilled nursing benefits for beneficiaries might need an update to incorporate palliative care services that are most commonly associated with hospice care, a new study suggests.

About 30% of elderly Medicare beneficiaries spend their last days in skilled nursing facilities rather than in hospice care, even if the facilities aren’t properly equipped for end-of-life care, according to a study published in the Archives of Internal Medicine, and it could be due to Medicare’s reimbursement system.

Nursing homes are more likely to offer short-term rehabilitation or long-term care rather than be equipped for palliative care (treating or preventing pain)—generally associated with hospice care. However, some patients who may be better suited for hospice end up in nursing homes because it can be less expensive, the study notes.


Medicare will cover or co-pay the first 100 days of a skilled nursing facility stay for beneficiaries who qualify with a three-day-minimum hospital stay, but it doesn’t cover room and board for hospice benefits, which must be paid out of pocket.

“Families often face an uncomfortable choice: either they pay for room and board out of pocket to have access to hospice services, or they continue under the Medicare SNF benefit, relying on nursing home services for palliative and end-of-life services,” the researchers wrote. “Perhaps having Medicare pay concurrently for post-acute SNF care and hospice services for the same condition could allow earlier incorporation of palliative care for these medically complex patients.”

The researchers found that out of about 5,100 people between 1994 and 2007 who were recently been discharged from the hospital, about 31% used Medicare’s nursing home benefits during the last six months of their lives. About 9% died while still using those benefits. Only 0.5% of those who died were enrolled in both the skilled nursing and hospice care benefits.


“I wish I could say that the results [of the study] are a surprise, but we have known for years that the reimbursement system and regulations for the SNF benefit discourages or at least delays access to hospice care,” said J. Donald Schumacher, the president and CEO of the National Hospice and Palliative Care Organization. 

Written by Alyssa Gerace