Today, it is more difficult for people who live in Texas nursing homes to receive hospice care. In the past, nursing homes had a little more incentive to refer dying patients to hospice. These are the issues that fuel the problem.
Nursing home reimbursement based on care level preventing referrals
In states where nursing homes receive reimbursement for care based on functional and clinical statuses of patients, there is more incentive to keep them. They receive a higher per diem for more severe cases. This means some nursing homes may prefer to keep patients instead of losing revenue by referring them to hospice.
Hospice room and board reimbursement reducing nursing home income
Hospices receive 95% of what room and board costs. They pass along this money to the nursing home, which means the nursing home must offer a discount for the patient’s cost to stay if the hospice will not make up the difference.
Pass-through provisions slowing nursing home payments
Medicaid and Medicare do not like to make multiple payments to different care providers. This is why they pay hospice for end-of-life care for a qualifying patient and let the entity pay the nursing home. For nursing homes, this means slower payments.
Organizational clashes hindering patient care
Nursing homes have always been viewed as places for end-of-life care. However, they also provide long-term care. Hospices focus on end-of-life care for people who qualify. Since both entities view themselves as primary end-of-life care providers, there can be organizational clashes that impede care for patients who need it.
Trying to deal with nursing homes alone can be difficult. Fortunately, there are several steps people can take to protect loved ones in nursing homes and their rights.