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End-of-Life Dilemma: Hospice or Nursing Home?

End-of-life care decisions are never easy, but many Medicare recipients are being forced to choose between nursing home or hospice care, although neither by themselves may be ideal for a patient nearing the end of life.

Nursing homes are great for providing around-the-clock care, but in general hospice care is considered to be better at treating end-of-life pain and suffering and for providing support for the patient and the patient's family.

But although Medicare provides a limited nursing home benefit as well as hospice coverage, it usually doesn't reimburse for both benefits at the same time, putting recipients in a tough position.

Medicare covers up to 100 days of "skilled nursing care" per illness following a hospitalization.  This coverage includes the cost (plus a co-payment after 20 days) of a semi-private room, meals, skilled nursing and rehabilitative services, and medically necessary supplies. Meanwhile, Medicare's hospice benefit covers doctor and nursing services, medical supplies, drugs, home health aide services, counseling and spiritual care, among other things, but it does not cover room and board.

Medicare won't pay for both benefits at the same time unless the patient is receiving the care for separate illnesses. This means that although a patient can receive hospice benefits in a nursing home, the patient would have to pay out of pocket for room and board if he or she chose to do so. In addition, patients must forgo aggressive treatment in order to receive hospice benefits, which may be scary. Not surprisingly a recent study  found that about one-third of Medicare recipients used the skilled nursing benefit at the end of life rather than the hospice benefit.

But officials are aware of the problem and things may be changing. As part of the Affordable Care Act the government is required to conduct a three-year study of providing concurrent care for Medicare patients. Participants at 15 hospice sites will be allowed both hospice and nursing home benefits at the same time.

For a New York Times blog post on the choice between hospice and nursing home care, click here.