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. 2018 Feb;21(2):188-193.
doi: 10.1089/jpm.2017.0099. Epub 2017 Aug 17.

Palliative Care Consults in U.S. Nursing Homes: Not Just for the Dying

Julie C Lima  1 , Susan C Miller  1
Affiliations

Palliative Care Consults in U.S. Nursing Homes: Not Just for the Dying

Julie C Lima et al. J Palliat Med. 2018 Feb.

Abstract

Background: Little is known about nursing home (NH) residents who receive palliative care (PC) consults in the United States.

Objective: Separately by short versus long (≥90 days) stays, to describe NH residents with PC consults compared to a prevalent NH sample.

Design: Descriptive longitudinal study.

Setting/subjects: NH residents in 2008-2010 in 54 NHs.

Measurements: Resident characteristics came from merged Medicare and NH data from the Centers for Medicare and Medicaid Services and consult information from two PC organizations that were the sole PC consult providers in the study NHs.

Results: Four percent of all NH residents received a PC consult during the study period. Two-thirds had short NH stays, and 81% of short- and 27% of long-stay consult recipients were on the Medicare skilled nursing facility (SNF) benefit at the time of initial consult. Short- and long-stay NH residents with PC consults differed not only, in many respects, from NH residents generally but also from each other. Despite these differences, half of short-stay and 57% of long-stay residents were alive six months after initial consults. Residents dead at six months died at 33.5 and 34.5 median days (respectively) after initial consults. At six months, 65% of surviving short-stay consult recipients were in the community without hospice, while 59% of long-stay residents were in the NH without hospice or Medicare SNF care.

Conclusion: The high rates of SNF care and six-month survival among NH recipients of PC consults demonstrate the utility of these consults before Medicare hospice eligibility or use.

Keywords: Medicare; nursing homes; palliative care.

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Conflict of interest statement

No competing financial interests exist.

Figures

<b>FIG. 1.</b>
FIG. 1.
Six-month survival from the date of initial palliative care consult.
<b>FIG. 2.</b>
FIG. 2.
Site of death for NH residents who received a palliative care consult by NH length of stay (those with six-month mortality). SNF, skilled nursing facility.
<b>FIG. 3.</b>
FIG. 3.
Among survivors, location of NH residents six months after having received an initial PC consult by NH length of stay.
See this image and copyright information in PMC

References

    1. IOM (Institute of Medicine): Dying in America: Improving Quality and Honoring Individual Preferences Near the End of Life. Washington, DC: The National Academies Press, 2015 - PubMed
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    1. Lester PE, Stefanacci RG, Feuerman M: Prevalence and description of palliative care in US nursing homes: A descriptive study. Am J Hosp Palliat Care 2016;33:171–177 - PubMed
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