Palliative Care Consults in US Nursing Homes: Not Just for the Dying

Background: Little is known about nursing home (NH) residents who receive palliative care (PC) consults in the United States. Objective: Separately by short versus long (>= 90 days) stays, to describe NH residents with PC consults compared to a prevalent NH sample. Design: Descriptive longitudinal study. Setting/Subjects: NH residents in 2008-2010 in 54 NHs. Measurements: Resident characteristics came from merged Medicare and NH data from the Centers for Medicare and Medicaid Services and consult information from two PC organizations that were the sole PC consult providers in the study NHs. Results: Four percent of all NH residents received a PC consult during the study period. Two-thirds had short NH stays, and 81% of short-and 27% of long-stay consult recipients were on the Medicare skilled nursing facility (SNF) benefit at the time of initial consult. Short-and long-stay NH residents with PC consults differed not only, in many respects, from NH residents generally but also from each other. Despite these differences, half of short-stay and 57% of long-stay residents were alive six months after initial consults. Residents dead at six months died at 33.5 and 34.5 median days (respectively) after initial consults. At six months, 65% of surviving short-stay consult recipients were in the community without hospice, while 59% of long-stay residents were in the NH without hospice or Medicare SNF care. Conclusion: The high rates of SNF care and six-month survival among NH recipients of PC consults demonstrate the utility of these consults before Medicare hospice eligibility or use.