hospice in LTC-cost?

[ktwlpn, LPN]

We were talking about this at break today.Our admin has always been very resistant to bringing in hospice for various reasons......( "we don't need some nurses coming in here telling US what to do"-well,yes...we DO) When a resident is on medicare or medicaid in a nursing home and they go on hospice how is the money disbursed between the hospice organization and the home? I would like to see us institute a comfort care protocol at the very least.I am so tired of watching dying residents continue to have labs drawn,rectal temps q 4 hours, with tylenol supps shoved up their bums and aggressive suctioning.I am REALLY tired of our doc's resistance to ggod pain control and many of my co-worker's outmoded attitudes towards giving the meds even when we do have them ordered.I am SO VERY SICK of watching several of my co-worker's trying to force feed these poor old souls...I am JUST TIRED,ya know? Tired of the status quo-tired of excuses....Luckily it looks like some of the old guard is finally moving on-things can only get better I think that maybe MONEY is the real reason why we have not welcomed hospice-that and our DON's need for absolute control over us all....

[hospicenurse]

We were talking about this at break today.Our admin has always been very resistant to bringing in hospice for various reasons......( "we don't need some nurses coming in here telling US what to do"-well,yes...we DO) When a resident is on medicare or medicaid in a nursing home and they go on hospice how is the money disbursed between the hospice organization and the home?

When a patient has both Medicare and Medicaid, the hospice bills Medicare for the hospice daily rate and bills Medicaid for the SNF Room & Board which it then reimburses to the SNF. If the patient only has Medicaid the hospice bills for both and reimburses the SNF. For private pay patients, the SNF bills the patient for R & B, and the hospice bills the pt. or bills their Medicare. Private insurances usually work out a situation similar to the Medicaid scenario. If the patient is there under MCR reimbursement, hospice can't start until MCR nursing home payment is finished, or the patient chooses to stop it and switch to hospice. Medicare will not pay both the hospice daily rate and the SNF R & B/Rehab rate (not sure what they call it).

According to Medicare regulations, Medicare patients are entitled to receive Hospice care in a SNF. Which means that the SNF could be in danger of losing MCR certification if they refuse to allow patients access to hospice.

Hospice has made a world of difference in end of life care in SNF's. Maybe a few families should start putting pressure on your administration to get hospice services (hint, hint). You could also contact area hospices, I'm sure they would be happy to send a rep over to discuss it with administration. Sometimes they just fear what they don't understand. And they need to be assured that they won't lose any money.

Gail