Previous SNF/LTC Director of nursing and previous hospice nurse here: There’s 2 sides to this financial story that you all may not be familiar with.
Example: Pt returns from acute care with orders for hospice (but could possibly meet SNF guidelines as well d/t medical condition). We’ll assume pt meets hospice guidelines as well but not actively passing within the next week or two.
-If pt admits under SNF all their needs are included in the lump sum payment the facility gets. This includes ALL meds, room & board, therapy costs. Assuming there’s been no previous SNF days used in past 60 days, this is covered 100% for the first 20 days.
-Now assume that hospice provides services upon readmit. The pt/family is now required to pay room and board (usually upfront for a month $5,000-8,000/month). Pt/family has to pay for all non-hospice meds that family might want to continue.
In each case, DNR measures are preserved. It’s VERY common that once a family finds they’ll be paying $200-300/ DAY vs nothing they ask to go with as many SNF days as possible. This often leaves the administrator (or DON) saying “Don’t worry we’ll take care of this for you” and thereby making the call to cancel hospice for the meantime (and hence making it look like they’re the bad guy if you don’t know the entire picture).
This from a DON/hospice nurse that 100% believes in the hospice philosophy of care but knows are Medicare system is highly flawed when it comes to this.