Hospice Care Thriving in Nursing Homes

Hospice utilization among nursing home residents has increased dramatically during the past five years. While most hospice patients receive care in a private residence, a rising number of patients are receiving care in assisted living and long term care facilities, according to a recent report from LeadingAge, an association of non-profit organizations that serve seniors.

During 2016, the most recent year for which data are available, 32 percent of Medicare decedents who opted into the hospice benefit passed away in a nursing facility, including nursing homes, assisted living facilities, and skilled nursing facilities. This is up from 14.5 percent in 2014, according to the National Hospice and Palliative Care Organization (NHPCO).

“Services are offered in the home, but they may be provided wherever the person calls home—whether that be an assisted living facility or a nursing home or any other type of residential facility,” according to the LeadingAge report.


Complementing this trend, the proportion of hospice agencies and nursing homes with common ownership has also grown substantially. Between 2005 and 2015, the number of hospices with common ownership of nursing homes grew to represent 1 out of every 5 Medicare-certified hospices. Similar increases were seen among nursing homes with common ownership of hospice agencies, the number of which rose to 20% of all nursing homes in 2015, up from 5 percent in 2005, according to 2018 research from the U.S. Department of Health and Human Services (HHS).

“Common ownership between hospice agencies and nursing homes is an emerging trend that reflects a broader push toward consolidation in the health care sector,” HHS reported. “It is possible that commonly-owned organizations have closer coordination between the nursing home and hospice, which could lead to earlier hospice enrollment.”

Earlier enrollment often leads to longer lengths of stay, and data from nursing homes with a commonly owned hospice support that claim. In 2015, patients receiving care from a hospice provider commonly owned with a nursing home had an average length of stay of 88.5 days, compared to an average 78.8 days for all nursing homes. The overall average length of state that year for hospice patients in all settings was 86.7 days.  


Most of the nursing homes and hospice agencies that share ownership are part of large chain organizations. This is indicative of the increasing dominance of for-profit players in the hospice space, as well as considerable merger and acquisition activity growing the footprint of national or multistate providers with diversified health care portfolios.

Though their length of stay may be longer, patients receiving care in a commonly owned nursing home tend to receive fewer and shorter hospice visits than hospice patients in other settings, according to HHS.

At the inception of the Medicare Hospice Benefit in 1983, nonprofits provided nearly all of hospice care in the United States. As of 2016, 67 percent of Medicare-certified hospice providers had a for-profit tax status, while the number of non-profit providers fell to 29%.

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