All medical treatments should have the goal of symptom control, and they should be consistent with the hospice plan of treatment. In the nursing home setting, some medications that are essential for good hospice care are typically weaned or controlled under regulations set by the Omnibus Reconciliation Act. However, these medications can be given appropriately, with careful documentation of their use in the patient's chart and care plan. One major hospice benefit is bereavement services for nursing home staff and residents who have become attached to the dying patient. Since these services are provided for a year after the patient's death, hospice staff and volunteers can, over the course of the bereavement period, assess and counsel those who cared for and about the patient.
Some hospices establish ongoing support groups for nursing home staff.
The high prevalence of dementia in nursing home patients makes the decision about palliative care more challenging than it is in patients without dementia. The Medicare Hospice Benefit covers all visits by hospice team members, the rental or purchase of durable medical equipment and the cost of supplies that are ordered by the hospice team. The hospice also supplies drugs for the palliation and management of the terminal illness, a benefit that normally is not available under the regular Medicare program. Thus, hospice care is not an additional expense for many nursing home residents. The Medicare Hospice Benefit cannot be provided for nursing home residents who are receiving skilled Medicare coverage if their diagnoses for both hospice and nursing home skilled care are the same.