Why Skilled Nursing, Assisted Living Operators Invest in Home-Based Hospice Programs

Offering hospice can be a game changer for skilled nursing and assisted living operators looking to stand out from competitors and improve patient reach. 

Home-based care, including hospice, has become an increasingly attractive space for facility-based health care providers of all walks. Assisted living and skilled nursing facilities (SNFs) have been joining the mix, taking varied routes to growth into home-based hospice care.

Similar to trends among health systems and hospitals, some have opened their own inpatient hospice centers or expanded their existing suite of services, while others have formed partnerships, joint ventures or pursued acquisitions.


These initiatives allow SNFs the opportunity to stretch care outside of their four walls at a time of heavy operational strain, according to David Klementz, CEO of Traditions Health, a portfolio company of Dorillton Capital Partners. 

“If you think about how they’ve taken on strains in their capacity, these post-acute services – home health and hospice – they can get patients out of very expensive settings,” Klementz told Hospice News at the Home Care 100 Conference. “They do the right thing for the patient, but don’t run these services like a hospice company runs it because it’s not a core business. [It’s] coordinating care with systems who will partner with you, collaborate with you to get the best patient outcome for you, because that’s their specialty. I don’t shy away from them getting into the space, as long as their quality of care and coordination of care with other settings is appropriate so the patient is getting the right outcome for their episode.”

Nationwide, about half of all hospice agencies are freestanding, while the remaining half are owned by other types of providers mainly home health agencies, hospitals and skilled nursing facilities, according to a report from the Medicare Payment Advisory Commission (MedPAC).


Providing home-based hospice can be a distinguisher for SNFs and assisted living providers,

not only capitalize on growing demand, but also to address a more comprehensive range of their patients’ health needs in the setting that most prefer.

Among the 1.6 million Medicare decedents who elected hospice in 2019,, nearly half (49%) received care in private homes, reported the Center for Medicare Advocacy. The other half was provided in nursing homes and at assisted living facilities (21% and 11%, respectively), according to the report. Data are not available for how any of these patients were cared for by a freestanding hospice entering those settings versus an in-house service.

As of 2019, more deaths were occurring in the home than in facility-based settings such as nursing homes and hospitals, according to a study in The New England Journal of Medicine. However, data for subsequent years may be skewed due to the effects of the COVID-19 pandemic.

Though hospice care in nursing homes was thriving prior to the pandemic’s onset, most SNFs and assisted living facilities were hit hard by the pandemic. Consequently, hospice providers had limited access to patients, making those in SNFs and assisted living facilities hard to reach.

These factors, coupled with rising demand for hospice and a swelling aging population, have some SNF and assisted living operators concerned about their capacity in terms of available space and staff. Partnering with home-based hospice, or launching their own service, enables them to expand care outside of their four walls, lighten patient caseloads for clinical staff and open up availability of patient rooms for those too sick to return home.

A drive to expand and improve care options in part drove the recent launch of Redbanks Nursing Home’s new hospice inpatient unit in Henderson, Kentucky. The non-profit has a skilled nursing, short-term rehabilitation and dementia care facility in the area and has provided services in the community for nearly 50 years.

Redbanks opened the unit through a partnership with St. Anthony’s Hospice. The nursing home renovated a space into a 16-bed inpatient hospice center featuring private patient rooms equipped for overnight family member stays, a family lounge area, a privacy room for family and friends and a renovated chapel.

The hospice center’s opening brings “a service so badly needed” to the community, Redbanks Executive Director Shari Newton stated during a ribbon cutting ceremony in January.

Skilled nursing operators stretching their arms into hospice could help to fill gaps in access to end-of-life care, especially for terminally ill patients who lack caregiver support, according to Hosparus Health CEO David Cook.

A rise of SNFs in hospice could lead to improved care coordination, as well as expanded options for patients, Cook said.

“If you look at minoritized communities, a lot of times you find that they don’t have an option to stay at home because they can’t afford to bring in support systems,” Cook told Hospice News at Home Care 100. “So they get into a situation where they can’t stay at home any longer, then end up going to a nursing home placement and that may not be the best solution for the individual or the family. There are things that we need to do to be able to support people with health care, and we’ve got to do it smarter, and sometimes coming together in a partnership where we can provide better quality of care for the individuals in the mix — then you’ve got a win-win.”

Workforce shortages proliferating across the health continuum have also been a driver for hospices and SNFs to collaborate. These partnerships create opportunities to reduce the impact of workforce shortages, he added.

“There’s a lot of opportunities and discussions that are happening that just weren’t happening before,” Cook continued. “I think workforce issues are pushing people to say, ‘What are we going to do differently? How are we going to do it?’”

Offering hospice strengthens the ability to better care for the complex needs of patients reaching the end of life or coping with multiple serious illnesses, according to Jennifer Hertzog, vice president of marketing and business development for Marquis Health Consulting Services. The company provides administrative and consulting services to skilled nursing facilities and senior housing communities across the East Coast.

Last year Marquis Health expanded its chronic illness support model, which includes palliative and hospice services. They rolled out the program across roughly 75% of its mid-Atlantic facilities. The move was made in growing recognition around a “void in the care we were providing in chronic illness management,” Hertzog previously told Hospice News sister publication Skilled Nursing News.

“Aligning care and services with other community providers allows us to be better prepared to manage patient’s complexities. Adding the palliative and hospice aspect into what we’re doing in chronic illness stage only positions us even more around the complexities and significant health care needs,” Hertzog said. We’re focused on enhancing care and differentiating services we offer so that they are patient-centered first and foremost, while better serving our communities to also differentiate ourselves from services and care routinely offered in our setting.”

While Marquis Health’s primary focus and wheelhouse resides in the skilled nursing and senior living space, the organization will additionally be focused on “bringing expertise and resources that further support and enhance that care,” including hospice and palliative services, Hertzog added.

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