In-house palliative care unit reduces longstanding SNF underutilization

In-house palliative care unit reduces longstanding SNF underutilization

While many nursing home patients who would qualify for hospice care never get it, a Pennsylvania provider is bolstering its end-of-life care efforts with a new 16-bed hospice unit.

This week, Masonic Village in rural Elizabethtown, Pennsylvania, saw 11 patients in its Evergreen unit which opened on Monday.

Vincent Mor, PhD, professor of health services, policy and practice at Brown University, said residential hospices remain rare in skilled nursing facilities, despite Medicare and Medicaid coverage. Typically, nursing homes have contracts with local hospices who “rent” beds which are then staffed with external employees to manage patients’ symptoms.

Nursing homes can provide aids, just as they do when nursing home residents choose to receive palliative care from a local provider.

“But, having a dedicated inpatient unit located in a nursing home that provides short stays for symptom management or to allow people to die outside of hospital in the same way as a community-based palliative care hospitalization is unusual,” Mor said. McKnight Long Term Care News. “It makes more sense in a rural setting that has a direct relationship with the local hospital so the hospital can refer patients who can’t go home or who are clearly dying but no longer have need for active care.”

Pandemic repositioning

Matthew Mayo, Deputy Executive Director of Masonic Villages and Administrator of the Health Care Center, said McKnight’s the nonprofit had long considered adding a designated palliative care unit, but had no space at its 453-bed skilled nursing facility.

That changed with the pandemic, and when the census dropped, administrators made the switch. Mayo said the original plan was for 12 beds, but after crunching the numbers with the goal of at least breaking even, 16 made the most sense.

The nonprofit already operates a 13-year-old freestanding hospice on the same campus, and staff in that building have provided training in hospice care. Evergreen staff had to re-interview for the new hospice roles, Mayo said.

Mayo admits her situation is unique. Donors paid for all the furniture – in addition to a bed, each room has a sofa bed, two televisions and a power recliner – a bill of $200,000. Most of the work to convert the space into 16 private bedrooms, a chapel, library, offices and a children’s playroom, was provided in-house.

“It’s not just about the residents, it’s also about taking care of the families,” Mayo said. “The future is to ensure that our residents have a great experience and that families feel well cared for. Are we taking care of our families? Do we take care of our staff?

Access to the hospice remains limited

Mor has long researched access to palliative care and almost 20 years ago he co-authored a paper arguing “that government concerns about possible abuse of palliative care provision in nursing homes, together with the suggestion that payment for provision in nursing homes may be excessive, may have slowed the uptake of palliative care services within the nursing home setting.

Studies conducted before federal regulators proposed reduced hospice payments for patients who live in nursing homes found that up to 24% of nursing home residents who die in nursing homes nurses are eligible for palliative care services, but only 6% were enrolled.

A more recent study by Kathleen Unroe of the Regenstrief Institute found that 33% of people who died in Indiana nursing homes were receiving palliative care, the same as the national average at the time, even though the Nursing home patients were older and more likely to have dementia.

On Wednesday, Mor said the addition of a hospice and palliative care unit remains a significant investment and regulatory review is under way. Stays require justifications every day after three days because patients are expected to die quickly.

“Indeed, many stays of people transferred directly from hospital are alive less than a day, which means that all the administrative costs of a stay are not amortized over a longer stay since they are paid day,” he said.

Other providers, however, have recognized that palliative care services can pay off in terms of patient care, community reputation and reimbursement when done well.

Andrew Salmon, future chief officer of Massachusetts-based Salmon Health & Retirement, said during a McKnight’s webinar Wednesday that identifying and transitioning appropriate patients into palliative care roles can mitigate the impact end-of-life patients might otherwise have on skilled nursing quality metrics.

“It’s good for the patient because there’s less pain and less suffering, and it’s also better for the building,” in terms of care planning and resource sharing, Salmon noted.

Editor Kimberly Marselas contributed

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