Palliative Care in Extended Care Facilities

Post by: PalliNP

When a loved one is in an extended care facility, Medicare rules will allow for 100 skilled care days. But what if that patient needs hospice care? Medicare will not pay for both hospice care and skilled nursing home care because they are both billed under part A. That leaves families with a large bill for room and board. Many cannot afford this, and so they forego hospice care in order to maximize their Medicare payments. If a patient has Medicaid coverage, they actually might be better off. Medicaid will pay for room and board and Medicare will pay for hospice.

Many extended care facilities are stepping into the gap with “palliative care”. What exactly is this care?

An interview with several staffers at ECFs that offer long term “palliative care” reveals that it is not what we have come to understand as palliative care. Comments such as “we can give morphine” and ‘we can give 24 hour care” show that much education is needed. The patient may get pain and symptom management and no one questions that a caring staff will try to provide that extra TLC. In an already overburdened system, the extra eyes ears and hands of hospice professionals would be welcomed. None of the staff, including the medical director, will likely have advanced palliative or hospice training and expertise. The patients and families in these programs do not get the hospice team or psychosocial support that hospice provides. But they are providing a service that is much needed, however incomplete.

What is needed is a major change in Medicare rules about extended care and hospice coverage. But until then, palliative care services are stepping up to support patients and families by bringing teams into facilities. Palliative care, unlike hospice, can be delivered alongside ECF care and will be paid for by Medicare under part B. In addition to advising and offering recommendations about care, the palliative team can model how to have difficult conversations, ways to explain the dying process and progression of disease, and offer staff education opportunities.


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