Medicare coverage for end of life/pallative care when not hospice


can someone please tell me how I can skill a resident who is on comfort care?I have tried to look it up in Medicare guidelines but all I am finding is in reference to Hospice Care?! have had 2 residents recently who were skilled but condition decline necessitated d/c from thrapy. Family chose not to go Hospice but preferred comfort care. These residents were exhibiting no pain . My therapy department is a little apprehensive to continue seeing a resident who has received a comfort care order (no progression) I would appreciate any info/guidelines you can help me with. thanks


1,010 Posts

Specializes in ER CCU MICU SICU LTC/SNF.

Did a physician document a "life expectancy of less than 6 months?" There is a very good reason the therapist is leary about providing therapy. Read all the conditions here p28-29 necessitating need for skilled therapy. To name a few...

  • The services must be provided with the expectation, based on the assessment made by the physician of the patient's restoration potential, that the condition of the patient will improve materially in a reasonable and generally predictable period of time, or the services must be necessary for the establishment of a safe and effective maintenance program;
  • The services must be considered under accepted standards of medical practice to be specific and effective treatment for the patient's condition; and,

If the resident recuperates unexpectedly, the therapist can resume the therapy within a certain time period, including deferred care situations.


39 Posts

Thank you very much. for the record I agree with my therapy department. This is very helpful!!!


128 Posts

Specializes in long term care - MDS. Has 22 years experience.

I know this is a month later, but things that might skill a palliative care patient could be things like pain management, respiratory support, suctioning, checking O2 sats and they may even be on chemo or radiation for palliative reasons, to shrink or help keep a tumor from growing and pressing on or blocking off other vital organs. Therapy might assist with pain management, tens unit, heat packs. Just a thought.


1 Post

Skilling a Resident for end of life care is my question also. Pain control to me would indicate a routine pain med was required, so what do I do with the dying Resident who gets prn pain control, not very often, and is too cognitively impaired to work with therapies. My DON insists he is still a skilled qualifier, as MDS Coordinator, I disagree.


28 Posts

Specializes in MDS/Medicare. Has 21 years experience.

I would consider keeping the patient on skilled also to prevent/manage skin issues, pain, physical and/or emotional, to name a few.