Options for Care

Place
1998
2002
2005
Hospital
56%
49%
45%

Nursing Home Long-term

19%
22%
22%
Hospice facility N/A N/A 1.37%
Home
21%
23%
24%
Other
4%
6%
6%
The CDC tracks mortality rates by place of death; the data reveals a pattern of end of life care in America. The majority of U.S. residents die in the acute care setting, whether in the emergency department, out-patient, or inpatient areas.
Acute hospital:
The clear majority of patients end their lives in acute care treatment facilities. It should be noted that acute-care hospitals, focus on curative treatment. Many patients die in intensive care units, or other hospital rooms, receiving prolonged futile "therapy" in an environment that does not lend itself to a peaceful death.
Skilled nursing facility:
Skilled nursing facilities may contract to provide hospice care. Some of theses SNFs have staff who have been specially trained to provide end of life care and pain management, but that is not true of all skilled nursing facilities.

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The majority of patients die in an acute care facility.
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Hospice/ Hospice home care:

Hospice care shares the goals of palliative care including: comfort, pain control and symptoms management. The difference lies in the populations served. Palliative care is delivered to patients seeking curative treatment. Hospice care serves patients with a terminal diagnosis and a life expectancy of less than six months.

Hospice care is a growing health care service. According to the National Hospice and Palliative Care Organization (NHPCO), 29% of all Americans who died in 1999 received some form of hospice service. By 2009, the NHPCO estimates that 41.6% of deaths in the U.S. were under the care of a hospice program:

The Medicare hospice benefit was created in 1983. According to Medicare law, most hospice care is to be delivered to people at “home,” or whatever constitutes home. Not all people who need hospice care are eligible for Medicare. Some insurance companies and state Medicaid systems also provide hospice benefits, but these benefits can be quite limited.

Hospice care is an elected benefit covered under Medicare Part A for a beneficiary who meets all of the following requirements::

The Medicare hospice benefit includes the following hospice services for the terminal illness and related conditions:

Medicare hospice benefits are provided in periods of care that require certification:

Once a patient has been certified for a time period, a hospice will receive Medicare payment for each day at 1 of 4 different rates, depending upon the care provided on a given day. Medicare payment rates to hospices vary according to regional labor costs.

Patient Coinsurance Payments


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