Additional benefits of hospice in the nursing home.

Abstract

To the Editor: Internal satisfaction surveys at Hospice of Palm Beach County confirm Baer and Hanson's conclusion that hospice improves the quality of care to terminally ill patients in nursing facilities.1 In addition to the benefits of hospice described in their study, however, we find that supplementing physical care with certified nursing assistants contributes significantly to the quality-of-life improvement. Medicare cutbacks have forced many nursing facilities to decrease their nursing and certified nursing assistant staff. Hospice helps to provide additional staff to ensure that the special needs of the terminally ill are met. In addition, hospice's expertise in pain management will be increasingly valuable to the nursing facilities, as well as to the patients, as the Joint Commission on the Accreditation of Healthcare Organizations pain management standards become an important new measure of quality health care. The diagnoses of the patients we serve at nursing facilities differ from that described by Baer and Hanson. Approximately 40% of our nursing facility patients have dementia and only 20% have cancer. This is a reflection of the diagnosis mix in the nursing facilities in this area. Length-of-stay parameters, however, are similar and consistent with the nationwide trend toward late hospice referral. Nursing facilities care for many patients who are terminally ill, the majority of them with noncancer diagnoses. The addition of hospice care for these patients clearly contributes to their quality of life and enhances the services of the nursing facility by offering expertise in pain and symptom management and supplementing the additional physical care needed by many dying patients.