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 Some 30% Of Elderly Medicare Patients Ending Days In SNFs, Study Finds

Nearly one-third of elderly Medicare patients were spending at least some of the last six months of their lives in skilled nursing facilities (SNFs) rather than in hospice care, a new study has found.
“Our study suggests that older, more clinically complex patients are using the SNF benefit near the end of life,” the researchers wrote in a study published online Monday in the Archives of Internal Medicine.
Examining the last months of some 5,163 Medicare patients, researchers found that many elderly patients were being released from the hospital and using their SNF benefits for the kind of palliative care normally associated with hospice care, the researchers found.
Those most likely to use the SNF benefits for end-of-life care were 85 years or older, had at least a high school education, did not have cancer, resided in a nursing home, used home health services, and were expected to die soon, the researchers found.
Of those patients who lived in the community and had used their SNF benefit, about 42 percent died in a nursing home, while 39 percent died in a hospital. Another 11 percent died at home, and 8 percent died elsewhere, the researchers found.
Those patients who didn’t use their SNF benefits were more likely to die in a hospital (44 percent) or at home (41 percent), the researchers found. About 5 percent died in a nursing home, and another 10 percent died elsewhere.
Although researchers were careful to call for further study, they did suggest that “financial issues” are leading the elderly and their families into SNFs for end-of-life care.
“Elderly patients living in the community who are becoming more symptomatic or are functionally declining may be admitted to the hospital because families cannot manage them at home,” the researchers wrote in Monday’s report.
This suggests that the SNF benefit ought to incorporate quality palliative care services in nursing homes, the authors said.
“Perhaps having Medicare pay concurrently for post-acute SNF care and hospice services for the same condition could allow earlier incorporation of palliative care for these medically complex patients,” the authors wrote.
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