Palliative care consults in nursing homes lead to fewer hospitalizations and less intensive treatment.
A study in the Journal of the American Geriatrics Society studied nursing home residents who died from 2006 to 2010 and found that hospitalization rates were the lowest when the initial palliative care consultation happened the furthest from death.
“These findings have never been shown in nursing homes,” author Susan Miller, PhD, MBA, a Brown University gerontologist and School of Public Health professor, said in a statement. “It’s important that we document this because essentially when people are in the nursing home for a long stay, that’s their final residence. These are people in need of supportive care and expertise in palliative care.”
The study found that for residents with initial consultations 8 to 30 days before death had a hospitalization rate in the last 7 days of life of 11.1% compared with a rate of 6.9% for patients with initial consultations 61 to 180 days before death.
Dr. Miller wasn’t surprised at the differences, but was surprised at how large the differences were.
Potentially burdensome transition rates were about 50% lower for residents with consults at 61 to 180 days before death compared with residents without consults. Transitions between settings can be physically and emotionally stressful for elderly, frail patients, and there is the risk of new medication side effects, exposure to resistant bacteria, and complications from procedures.
Palliative care consults are not used more frequently because unlike hospice care, palliative care consults are not a distinct benefit under Medicare. The payment for providers is usually not much.
Hospice care is used when the patient is likely to die within 6 months and many elderly people in nursing homes have serious illnesses that aren’t necessarily terminal. As a result, the hospice benefit may not be an option, but consults to access palliative care could benefit them.
“There are a lot of things that we need to consider,” Dr. Miller said. “If we had payment for this and there were more people providing it there would be greater access and maybe different people using it.”