It is patterned on the Medicare hospice benefit, and is governed by all the Medicare statutory and regulatory requirements. The hospice benefit is available to persons whom a physician certifies are terminally ill and have a prognosis of no more than six months to live. It emphasizes palliative care to relieve pain and control symptoms rather than attempt to cure. Medicaid beneficiaries can receive hospice benefits while residing in nursing facilities. The hospice is responsible for the professional management of care for the individual's terminal illness.
Most people assume hospice care is provided to patients in their own homes.
In fact, by allowing hospice care to be provided also in the nursing facility, the locus of care is frequently the nursing home. The result, in my view, is unduly expensive. The current federal statute and regulations governing hospice care should be changed to give states more flexibility. First, the states should be allowed the option to provide the hospice benefit only in the home. Rather than working together for the maximum benefit of consumers, each part of the system is motivated to guard its resources jealously, shifting patients and their costs to the other part of the system rather than managing those costs.