In a report titled, “The Growth of Hospice Care in U.S. Nursing Homes,” presented at the 2010 Annual Meeting of the American Association of Hospice and Palliative Medicine in Boston, authors Susan Miller, Julie Lima, Pedro Gozalo, and Vincent Mor explored the issue of more hospice in skilled nursing facilities (SNFs).
Miller, who like most of the report authors, works at the Center for Gerontology and Health Care Research and Department of Community Health, Alpert Medical School, Brown University, says that much more research is needed into the particulars of hospice growth in SNFs, but the facts are clear in her report.

Between 1999 and 2006, the number of hospices providing care in nursing facilities grew from 1,850 to 2,768, and rates of nursing facility hospice use more than doubled, from 14 percent to 33 percent.

With the growth came a doubling of mean lengths of stay from 46 to 93 days and a 14 percent increase in the proportion of nursing facility hospice decedents with non-cancer diagnoses, 69 percent in 1999 to 83 percent in 2006.

For instance, the proportion of hospice stays longer than 180 days rose from 6.6 percent in 1999 to 15.6 percent in 2006, but hospice stays of seven days or less remained relatively stable at around 30 percent.

Non-cancer Patients Increase

Although the number of Medicare hospice beneficiaries in nursing facilities doubled from 101,843 in 1999 to 233,844 in 2006 (the last year available), the proportion of beneficiaries who were in nursing facilities largely mirrored the overall growth in the Medicare hospice program. In 1999, 21.7 percent of Medicare hospice beneficiaries resided in SNFs; this rose to 24.2 percent in 2002 and remained constant through 2006, at around 25 percent.
The demographics for SNF hospice decedents changed little across the study years. Most were female (67 percent) and white (90 percent), and more than half were aged 85 and older. In 1999, 11.9 percent of SNF decedents with non-cancer diagnoses and 23 percent with cancer diagnoses accessed hospice; in 2006, these rates rose to 31.4 percent and 51.3 percent, respectively.
Miller says the concern is although greater access to hospice care in nursing facilities had been promoted, greater access appears to come at a cost of longer stays, and these have resulted in increased Medicare hospice expenditures.​