Featured Research

from universities, journals, and other organizations

High use of U.S. Medicare skilled nursing benefit at end of life, study suggests

Date:
October 1, 2012
Source:
JAMA and Archives Journals
Summary:
Almost one-third of older adults received care in a skilled nursing facility in the last six months of life under the U.S. Medicare post-hospitalization benefit, according to a new study.

Almost one-third of older adults received care in a skilled nursing facility in the last six months of life under the Medicare posthospitalization benefit, according to a report published Online First by Archives of Internal Medicine, a JAMA Network publication.

While most Medicare beneficiaries enroll in skilled nursing facility (SNF) care for rehabilitation or life-prolonging care, experience suggests that some dying patients are discharged to a SNF for end-of-life care. Switching patients from Medicare coverage under the SNF benefit to the hospice benefit has financial implications for the patient and for the nursing home. Unlike the SNF benefit, the hospice benefit does not pay for room and board, which means patients who transition to the hospice benefit must pay out of pocket or by enrolling in Medicaid, for which many patients do not qualify, according to the study background.

Katherine Aragon, M.D., of the University of California, San Francisco, and colleagues used data from the Health and Retirement Study, a nationally representative survey of older adults, linked to Medicare claims (1994 through 2007) to examine the use of the Medicare posthospitalization SNF benefit at the end of life. The study included 5,163 Medicare participants who had died at an average age of nearly 83 years.

"Our finding that Medicare decedents commonly used SNF 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," the authors comment.

In total, about 30 percent of the participants had used the SNF benefit in the last six months of life and about 9 percent had died while enrolled in the SNF benefit. The use of the SNF benefit was greater among patients who were 85 or older, had at least a high school education, did not have cancer, resided in a nursing home, used home health services and were expected to die soon, according to the study results.

Of the participants who lived in the community and had used the SNF benefit, about 42 percent died in a nursing home, nearly 11 percent died at home, nearly 39 percent died in the hospital and 8 percent died elsewhere. In contrast, of those participants who lived in the community but did not use the SNF benefit, about 5 percent died in a nursing home, almost 41 percent died at home, about 44 percent died in the hospital and nearly 10 percent died elsewhere, the study results also indicate.

"Unfortunately, financial issues may contribute to why patients near the end of life are using the SNF benefit and not the hospice benefit. Elderly patients living in the community who are becoming more symptomatic or are functionally declining may be admitted to the hospital because families cannot manage them at home. Our study suggests that older, more clinically complex patients are using the SNF benefit near the end of life," the authors note.

The authors conclude that high Medicare SNF benefit use at the end of life highlights the need to incorporate quality palliative care services in nursing home.

"The hospice benefit is the primary way in which palliative care services are provided in nursing homes. A growing focus is on the development of palliative care in nursing homes alongside the current goals of functional improvement. Perhaps having Medicare pay concurrently for postacute SNF care and hospice services for the same condition could allow earlier incorporation of palliative care for these medically complex patients," the authors conclude.

Commentary: Aligning Prognosis, Patient Goals, Policy and Care Models

In an invited commentary, Peter A. Boling, M.D., of Virginia Commonwealth University, Richmond, 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."

"Continuity of care and the processes required to resolve complex issues are often fractured in contemporary health care, resulting in care that is ultimately not what many reasonable persons would choose," Boling continues.

"Without doubt, the SNF benefit is too often used on admission to nursing homes for patients in whom the expected outcome is death because of incentives for the facility and financial burdens on the family that come from using the Medicare hospice benefit at the outset of nursing home care. Clinical practice and health care policy should perform better in this context, and this ultimately ties back to alignment of incentives," Boling concludes.


Story Source:

The above story is based on materials provided by JAMA and Archives Journals. Note: Materials may be edited for content and length.


Journal References:

  1. Aragon K, Covinsky K, Miao Y, Boscardin W, Flint L, Smith AK. Use of the Medicare Posthospitalization Skilled Nursing Benefit in the Last 6 Months of Life. Archives of Internal Medicine, 2012; DOI: 10.1001/archinternmed.2012.4451
  2. Boling PA. Aligning Prognosis, Patient Goals, Policy, and Care Models for Palliative Care in Nursing Homes. Archives of Internal Medicine, 2012; DOI: 10.1001/2013.jamainternmed.592

Cite This Page:

JAMA and Archives Journals. "High use of U.S. Medicare skilled nursing benefit at end of life, study suggests." ScienceDaily. ScienceDaily, 1 October 2012. <www.sciencedaily.com/releases/2012/10/121001161438.htm>.
JAMA and Archives Journals. (2012, October 1). High use of U.S. Medicare skilled nursing benefit at end of life, study suggests. ScienceDaily. Retrieved July 31, 2014 from www.sciencedaily.com/releases/2012/10/121001161438.htm
JAMA and Archives Journals. "High use of U.S. Medicare skilled nursing benefit at end of life, study suggests." ScienceDaily. www.sciencedaily.com/releases/2012/10/121001161438.htm (accessed July 31, 2014).

Share This




More Health & Medicine News

Thursday, July 31, 2014

Featured Research

from universities, journals, and other organizations


Featured Videos

from AP, Reuters, AFP, and other news services

Dangerous Bacteria Kills One in Florida

Dangerous Bacteria Kills One in Florida

AP (July 31, 2014) Sarasota County, Florida health officials have issued a warning against eating raw oysters and exposing open wounds to coastal and inland waters after a dangerous bacteria killed one person and made another sick. (July 31) Video provided by AP
Powered by NewsLook.com
Health Insurers' Profits Slide

Health Insurers' Profits Slide

Reuters - Business Video Online (July 30, 2014) Obamacare-related costs were said to be behind the profit plunge at Wellpoint and Humana, but Wellpoint sees the new exchanges boosting its earnings for the full year. Fred Katayama reports. Video provided by Reuters
Powered by NewsLook.com
Peace Corps Pulls Workers From W. Africa Over Ebola Fears

Peace Corps Pulls Workers From W. Africa Over Ebola Fears

Newsy (July 30, 2014) The Peace Corps is one of several U.S.-based organizations to pull workers out of West Africa because of the Ebola outbreak. Video provided by Newsy
Powered by NewsLook.com
Weather Kills 2K A Year, But Storms Aren't The Main Offender

Weather Kills 2K A Year, But Storms Aren't The Main Offender

Newsy (July 30, 2014) Health officials say 2,000 deaths occur each year in the U.S. due to weather, but it's excessive heat and cold that claim the most lives. Video provided by Newsy
Powered by NewsLook.com

Search ScienceDaily

Number of stories in archives: 140,361

Find with keyword(s):
Enter a keyword or phrase to search ScienceDaily for related topics and research stories.

Save/Print:
Share:

Breaking News:
from the past week

In Other News

... from NewsDaily.com

Science News

Health News

    Environment News

    Technology News



      Save/Print:
      Share:

      Free Subscriptions


      Get the latest science news with ScienceDaily's free email newsletters, updated daily and weekly. Or view hourly updated newsfeeds in your RSS reader:

      Get Social & Mobile


      Keep up to date with the latest news from ScienceDaily via social networks and mobile apps:

      Have Feedback?


      Tell us what you think of ScienceDaily -- we welcome both positive and negative comments. Have any problems using the site? Questions?
      Mobile: iPhone Android Web
      Follow: Facebook Twitter Google+
      Subscribe: RSS Feeds Email Newsletters
      Latest Headlines Health & Medicine Mind & Brain Space & Time Matter & Energy Computers & Math Plants & Animals Earth & Climate Fossils & Ruins