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One Surprising Reason Elders Don’t Get Optimal End-of-Life Care

One Surprising Reason Elders Don’t Get Optimal End-of-Life Care

Nearly one-third of elderly Americans turn to skilled nursing care during their last few months of life, despite the fact that some may be better served by seeking palliative care services, such as hospice, according to a recent analysis published in the Archives of Internal Medicine.

Researchers from the University of California, San Francisco (UCSF) discovered that 31 percent of Medicare beneficiaries who were newly released from the hospital utilized the program’s skilled nursing benefit (the program pays for up to 100 days of nursing home care if a senior was hospitalized for three or more days) in their last six months of life.

What was surprising was that many of these aging adults failed to take advantage of Medicare hospice coverage during this time, even though elders who reside in nursing homes can apply to receive additional palliative care if they are close to death.

This finding raises the question of whether or not these ailing adults are getting the optimal care for their terminal conditions.

Skilled nursing facilities primarily deliver care aimed at either getting an elder functional and back on their feet, or prolonging their life through medical intervention. Hospice care, on the other hand, strives to help an elder (and their family) manage the physical and mental pain of a terminal illness such as cancer or Alzheimer’s disease.

A case for a better benefits structure

Not all nursing homes are equipped with the staff and resources necessary to provide proper palliative care, according to commentary on the study, written by Peter Boling, M.D., of Virginia Commonwealth University.

“The use of the hospice care benefit improves the quality of end-of-life care processes for many patients in nursing homes,” he says.

Both Boling and the UCSF researchers feel that cost considerations are compelling many Medicare beneficiaries to stick with skilled nursing care alone, rather than accept additional help from hospice providers.

A senior staying in a skilled nursing facility can apply to receive outside hospice care—if they have less than six months left to live. But Medicare’s current benefits structure means they’ll have to fork over more money for their living expenses (lodging, meals, etc.), either through private pay, Medicaid or supplemental insurance.
Study authors say dying seniors may benefit from a plan that better integrates palliative care services into Medicare’s nursing home coverage.

Are Dying Seniors Getting the Care They Need? originally appeared on AgingCare.com.

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Why Family Members Wait too Long to Call Hospice
How to Talk About End-of-Life Issues With a Loved One
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6 Common Hospice Care Myths

Read more: Aging, General Health, Health, , ,

: By Anne-Marie Botek, AgingCare.com Editor

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AgingCare.com connects family caregivers and provides support, resources, expert advice and senior housing options for people caring for their elderly parents. AgingCare.com is a trusted resource that visitors rely on every day to find inspiration, make informed decisions, and ease the stress of caregiving.

94 comments

+ add your own
1:35AM PDT on Sep 4, 2013

Deborah W.

So very well said !

I know the facilities cannot force the residents to get into the bathing area for a good bath, but at least something CAN be done to keep them clean ( with communication with the resident and trust in the technichians )

And just from experience, when leaving from seeing my mom, if I see someone sitting alone, I will sit next to them & say something like " boy I'm tired ! " I do not jump into their face with the sympathetic talk.

Most of the time a few comments are made between the resident & me, or a full blown convensation will bloom !

Either way, a seed of happiness is planted for comfort in more than one heart that day. I always end with, I enjoyed talking with you & maybe we will see each other next time.

IT IS hard & demanding work for the family & the techs.

Understaffing is everywhere, yet squeezes through on the "looks good on paper " technique.

Those of you out there & have not experienced this yet,
PLEASE DO NOT ABANDON YOUR FRIEND OR FAMILY MEMBER.

It can so often be an exhausting battle to see things done wrong & to get them corrected.

3:05PM PDT on Sep 2, 2013

Sorry for the rant, it can be a nonstop battle.
It can be exhausting.

And, promises made to patronized those who complain.

Been there, done it.

CARE2 FIX THE CUT OFFS !!!

3:04PM PDT on Sep 2, 2013

WE DO NOT EVEN HAVE ENOUGH SOCIAL WORKERS TO MONITOR
CHILD PROTECTION IN ORPHANAGES, FOSTER HOMES, & AT RISK FAMILIES.

ASSISTIED LIVING FACILITIES, SKILLED NURSING FACILITIES & HOSPICE FACILITIES
ARE MONEY MONGERS TOO.

SOME PATIENTS ARE AFRAID TO COMPLAIN.

FOR MANY REASONS THAT MAY COME TO MIND,
IF YOU HAVE EXPERIENCED A FRIEND OR FAMILY MEMBER
IN ONE OF THESE FACILITIES.

I HAVE SEEN IT, MY FAMILY HAS SEEN IT.
DEMANDING NOTIFICATIONS ARE MADE TO THE FACILITY HEADS.

IF THAT DOES NOT WORK,
IMMEDIATE NOTIFICATION TO AUTHORITIES,
WHO UNDER THE LAW NEED TO BE DEMANDED IMMEDIATELY.

DO NOT WARN THE FACILITY THAT THIS NOTIFICATION HAS BEEN MADE,
UNLESS YOUR NON STOP DEMANDS COMPLAINTS ARE FIXED.
1 WARNING TO THE FACILITY IS >>>>> ENOUGH !

3:03PM PDT on Sep 2, 2013

> SOCIAL WORKERS TO VISIT FACILITIES

3:02PM PDT on Sep 2, 2013

here we go again with the cut offs....

It should be A LAW THAT THAT MEDICARE & MEDICAID EXPEDITE THE PATIENT TO AN
>>> IDEAL

3:00PM PDT on Sep 2, 2013

In that case ………IT SHOULD BE A _____ LAW _____ THAT >>> DOCTORS NOTIFY SOCIAL WORKERS TO VISIT FACILITIES >>> ENOUGH !

9:23PM PDT on Aug 15, 2013

I am elderly, live alone, have no family and am chronically-ill, mostly bed-ridden. So this subject matter is really scary to me, especially since I also don't have much money. I can't even afford a decent retirement community. So I am still living in the same place, without any assistance.

I may not live very long, but who knows I may hang in there. I have various illnesses, but not one of them has a prognosis of a 6-month to death duration (with my most severe one, no one has even been able to reach a diagnosis, not knowing what's the cause), so I am not eligible for hospice care.

If I had a choice, and even with Medicare it's not cheap, I would want to enter into a hospice facility. They generally are much nicer than nursing homes, at least in my location (which isn't saying much). There are 2 major ones here, one being a lot better than another with a very long waiting list. I placed my mother in the better of the two, luckily getting in with the help of her doctor. Even in this care facility, there were problems, I would not have anticipated. If were not for my presence (she was there for just 2 days!), my mother would not have received the best of care. She was to receive morphine, as needed, yet they rarely came into the room to check on her. I had to keep requesting a dose when she was gasping for air!

There were other issues, but the main point is that it certainly makes a difference if a family member can provide oversight, even in the best of p

9:04PM PDT on Aug 15, 2013

Ever tour today's facility offerings?

Nursing facilities would never explore the possible better-served resources mentioned ... hospice or palliative care ... they're in it for the money created by the numbers they admit. And more often than not, residents remain just that, "numbers" ... tended to for only bare-bone necessities of feeding, changing, bathing -- rarely offered activities, social interaction, even a friendly word by overworked, understaffed shifts, with minimal pretraining.

The lucky ones may find some solace in family member visits ... while those who have no one sit in the hallway and watch. These are somebody's father/mother/sister/brother/relative/friend/neighbor and deserve peace and safety in their last years ... thank God for the volunteers who see this as a mission of mercy and get involved.

8:58PM PDT on Aug 14, 2013

thnx for this

8:58PM PDT on Aug 14, 2013

thnx for this

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Disclaimer: The views expressed above are solely those of the author and may not reflect those of
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