Hospice Care is Different than Regular Health Care

Hospice is Not About Improving but About Feeling Comfortable 

Hospice care differs significantly from the type of care that we typically think of for health care.

First and foremost, hospice care is palliative care.  That means that the focus is on providing comfort and support, making the patient feel comfortable.  With hospice care the focus is not on treatments meant to cure an illness or help a patient recover from an injury. The difference may seem subtle but it has profound consequences.  Occupational and physical therapy is out.  Most treatments are curtailed.  A doctor trained in hospice care will review the patient’s medications and will stop or reduce many that are not specifically related to the patient’s immediate comfort.

NursingHomeDatabase provides an easy way to find the hospice providers in your area with detailed reports on each hospice provider which can help you to make an informed decision on which provider to choose.

Palliative care is about relieving the symptoms associated with a terminal illness. This typically means pain management.  Here also things are different.  Many medications like opioids that would not be prescribed to patients for fear of addiction are freely available to the hospice patient.

Hospice also address Psychological and Spiritual Issues

Along with the physical concerns, hospice will also attempt to help the patient deal with the psychological and spiritual issues that confront everyone who is dying. (How different is this from normal health care that gives very little attention to anything other than the physical issues confronting the patient.)  This help typically includes both secular assistance by counsels or social workers as well as religious professionals like priests, nuns, or other religious practitioners. 

Hospice Care is Also for the Family

Hospice care is not just for the patient—it is also for the family and friends of the patient. Hospice care provides emotional and practical support for families who are dealing with a life-limiting illness. The hospice team can help families understand what to expect, manage symptoms, make decisions about treatment, and cope with their grief. 

Grief counseling and religious services are available to the family and friends of the patient during hospice care and for up to a year after the patient’s death. Grief counselors and religious practitioners can offer support and guidance as the family grieves. They can also help the family to process their feelings and emotions.  Counselors will often proactively reach out to family members to offer support and consolation.

Hospice – Special Facility or Home Environment, You Choose

Unlike regular medical care, hospice patients are not expected to go to see their medical professionals, the care comes to them.

There are many different types of hospice care, but the two main types are home hospice and facility-based hospice. Home hospice is when hospice care is delivered in the patient’s home, and facility-based hospice is when it’s delivered in a special facility like a nursing home or hospital.  This option also includes special group homes that are often normal single family homes but with the addition of nursing staff available 24 hours a day.  These group homes have the benefit that they are more comfortable for the patient and the family than a hospital or skilled nursing facility.

Both types of hospice have their own advantages and disadvantages, so it’s important to talk to your doctor or Hospice provider to see which one would be best for you or your loved one.

Hospice is Covered by Medicare

Medicare typically covers all the costs related to hospice care for a period of up to 90 days regardless of any patient deductibles.  It is important to understand that the coverage applies only to the medical professionals and the medications.  Medicare does not include costs for the hospice facility nor does it cover any costs after death.

After the initial 90 day period, patients on hospice are not out of luck.  Medicare allows for a second 90 coverage period. Patients still on hospice after 180 days can continue on hospice provided that a doctor meets with the patient in person and reauthorizes hospice treatment.  This reauthorization is for a 60 day period and can be renewed every 60 days. Some patients can remain on hospice care for years.

Hospice is Not Always the End- You Can Change Back

While someone may be told that they need hospice care, this does not always mean that they are going to die soon.  Some patients remain in hospice care for years.  Other patients improve and are moved off of hospice care.  

It is important to note that there is a clear line that distinguishes hospice care from regular health care.  If a hospice patient decides that they want to go to a doctor or to the hospital for some form of treatment, they will be taken off of hospice care.

Leaving hospice does not mean that you cannot return.  Patients can come and go from hospice as often as is needed.

More than Nursing Homes

There’s a lot of data out there and a lot of it is coming from the Centers for Medicare & Medicaid Services (CMS). We’re committed to making sure that you have access to all the data you need, and we’re constantly working to cover more ground. In this blog post, we’ll give you an overview of what CMS publishes, how you can access it, and what we’re doing to make sure that you can find everything you need.

What does CMS publish?

Here’s a list of the datasets that we making available:

Data for each of these health care areas is updated sporadically. We monitor CMS for updates and update our health care database as soon as new data is available.

We also aim to improve the quality of the data that CMS provides, including by finding new ways to assess the data (e.g. through lists of ratings upgrades and downgrades).

Here We Are Again

After more than a year’s effort and a considerable amount of money spent on SEO experts, we are now redirecting everything from seniorcaredata.com back to nursinghomedatabase.com.  The simple explanation for this is Google’s algorithm did not like the change.

I’ve covered the back story about why we decided to change domain names in a prior post.  

At the end of the day, the new site never could catch up to this site.  Even with many more pages, over 2 million compared to about 250,000 here, the new site was not performing as well.  Looking back, I think we should have redirected all our traffic to the new site, but at the time, we thought we could keep both sites running.

Apparently Google’s algorithm did not agree with our transition.  Activity was picking up gradually at the new site, but for some reason it just dropped to nearly zero a few weeks ago.  The general consensus is that Google thought SCD was scrapping NHD.  We had spent countless hours trying to make the two sites look different and to make sure that the similar pages covering nursing homes showed the data differently.  But I guess it was not enough.

I don’t have time to wait for Google to figure this out.  If it doesn’t like something, then I think the best thing is to change what we are doing.  (If you have ever tried to deal with Google you know that there isn’t anyone you can call or chat with that you can initiate to get an explanation for what happened.  It just happens and you have to react.)

So here we are again.  The domain name does not adequately express what data is available on the site, but hopefully that will not stop people from coming to take a look.

A new domain…

tl;dr: We have launched a new domain (seniorcaredata.com) which will allow us to delve into many other datasets that CMS and others publish.

When we first put together the pages for this site, we wanted to answer one simple question: what did all of this data from CMS mean? We had found that the Centers for Medicare & Medicaid were publishing large datasets monthly covering what appeared to be all of the skilled nursing homes in the United States. This was interesting information, but it is hard to understand what is going on simply by pouring through Excel spreadsheets containing tens to hundreds of thousands of records.

Our first insight was to put all of this data together on one page where you easily see all of the data for a specific facility that was currently spread across more than 10 datasets and hundreds of rows. Once we had that, we could start asking other questions and organize the data in many different ways, homes by state, by city, homes by ratings, and on and on. Then by collecting the records from other time periods we could also start to look at what was happening over time.

We have just begun to scratch the surface on the data; we’re finding new and interesting insights daily.

But, it turns out that CMS publishes data for more than just skilled nursing facilities. We’re finding new records regularly. Most recently we found data on doctors and doctors groups. This has proven to be a very interesting data set as it provides some insight into to costs.

After some anguish over what to do, we decided to continue digging into this data but to use a different domain name. Nursinghomedatabase.com seemed like a really good choice when we started but it looks strange for people who want to find out about hospitals, or dialysis centers, other whatever else.

A few months ago, we quietly launched the new domain, seniorcaredata.com.

For those who do not know, changing to a new domain can be a difficult process. Google and other search engines take a long time to index your site and start including your links in their search results. Almost all of our traffic comes not from going to are home page but from clicks related to specific homes or lists. Indexing can therefore become a real issue if your site has more than 200,000 pages! Even now several years have launching this site, Google does not include the majority of our pages in their search results.

Nursinghomedatabase.com has been growing very steadily for the past few years. In June we surpassed 140,000 monthly page views. We certainly do not want to lose this momentum. So, what we are going to do is maintain this site which will be true to its name and focus on the skilled nursing home data. SeniorCareData.com will provide this information too and will extend into all the other datasets that we finding.

Inspection Risk Continues for Nursing Homes

CMS just updated their data for nursing homes today and unfortunately the average lag time between nursing home inspections continues to rise.

As I noted last month, the average time between inspections has risen significantly during the Covid pandemic. For several months, CMS did not report an inspections. For the month of April, CMS shows 43 new inspections. This is insufficient to curtail the continued rise in lag time. For May 1st 2021 the average lag time is 540 days, up from 529 days last month.

We updated our chart showing the increase in average lag time to show the number of inspections reported monthly.

Covid-19 Not the Only Risk for Nursing Home Residents

I held off on publishing this article because I do not want to say something that is inappropriate in the middle of the Covid pandemic. But it seems like a significant concern.

Specifically I am writing about the fact that average time since being inspected by CMS continues to grow. As you can see from this chart that we posted last month, what is supposed to be an annual inspection has now risen to an average of 529 days (or nearly 18 months). By comparison before the pandemic this average hovered around 250 days (or 8.3 months). This is more than double the average time between inspections pre-pandemic!

What does this mean? Hopefully it does not impact patient care. Nursing homes are licensed by the states, so ideally this oversight continues.

At a minimum it means that the data is not as good as it has historically been and that CMS Five Star Quality Rating System (which we have discussed previously as very flawed) is even less reliable.

The latest data which has a date of March 1st, 2021 shows that inspections are beginning again. There were no inspections reported from May 1, 2020 through December 1, 2020. The data for January 1, 2021 shows inspections starting again and rising to 20 for March 1st and 33 for April 1st. Still this is significantly below the 80 to 90 that were inspected monthly prior to the pandemic.

As time goes by this inspection backlog will only get worse if CMS is not able to significantly ramp up its efforts. The latest provider information includes data on 15,328 nursing homes. At a rate of 33 inspections per month it will take 464 months to inspect every home.

At a time when nursing homes are suffering the lack of transparency makes it even more difficult.

Monitor Your Nursing Home

Last month we quietly launched a new feature allowing people to “monitor” a specific senior care facilities. We did this by adding a button below the page heading entitled “Subscribe to Updates to the Facility”. Now we’ve sent out the first emails to our “subscribers”.

I thought I should say something about what we mean by monitor or subscribe. The facility records that are shown on our website are updated from time to time. For nursing homes, this happens monthly. (We’re still trying to determine how regularly other CMS records are updated.) When that happens we retrieve the updated records and go through an extensive process of bringing in the new data. Part of the work that is done is to compare the new record to the prior record. Did the nursing home’s five star rating change? Did the rating score change? What about the number of infections at the facility? We show this information on the website, and now this information, along with a list of newly added deficiencies, is also being sent out to the subscribers.

This makes it very easy for someone to stay up to date and know right away about what is happening with a nursing home or other healthcare facility that you are concerned with.

We plan to continue to improve on this reporting tool as we find more information or comparisons that we see as important.

The Fault in CMS’ Stars

The Centers for Medicare and Medicaid Services (“CMS”) spends considerable time and effort promoting their Five Star Quality Rating System for Nursing Homes (see here).  They even provide an extensive analysis of how they arrive at their ratings (see here).  The ratings are based on a complicated scoring system that involves multiple factors including: both state and agency health inspections, staffing levels and quality measures.  The stars shine brightly on the individual facility web pages along with all of the private pages covering the facilities.

There’s just one problem with this system.  It is not accurate.

All of the ingredients that I mentioned above plus many more are compiled by CMS into a single number which was called a “cycle score” and now is referred to as a “rating score”.  It’s what happens next that creates the problem.  Once they have that number they first group the facilities by state and then by rating score (lowest to highest).  

Did you catch that first step?  CMS first groups the facilities by state, then ranks them.  The top ten percent of the facilities in each state receive five stars while the bottom 20 percent receive one star.  And that how a facility earns its stars; it is simply a ranking of the facilities in a particular state by ratings score with the stars indicating what ranking the facility has achieved in the state.

What this means is that it is not accurate to compare a nursing home in one state to a nursing home in another state using CMS’s Five Star Quality Rating System.  It is comparing apples to oranges.  To further illustrate this oddity, we have put together a presentation of what CMS calls its “Cut Point Table”.   This table shows the range of ratings scores that a nursing home needs to qualify for the different star levels in each state.  At the opposite ends of the spectrum are New Hampshire and Nevada.  New Hampshire which only has 73 facilities is the most difficult state, requiring a ratings score of less than .667 to qualify for a five star rating.  Compare that to Nevada which has 62 facilities but only requires a 40 for a five star rating.  Worse still having a 39 rating in New Hampshire means that you would only be a one star facility.  In New Hampshire a ratings score of 20.667 was the lower limit for two stars. (Strangely too, the data for this tables comes from a CMS PDF document. The data is not actually available as structured data but only as an unstructured PDF.) Here is a page with the latest data.

So, a five star nursing home in Nevada could be worse than a one star nursing home in New Hampshire!  How does that make sense?

Piling on to this problem is the fact that CMS does not make it easy to find the rating score.  It is available in the data that they publish (and so we have it), but they do not provide it on their pages.  

So that’s it.  The Five Star Quality Rating System for Nursing Homes is tragically flawed. You cannot easily compared facilities from one state to another. There is a better system, but it is not easy to find.

Luckily, we can help.  Each of the nursing home pages that we present shows all of the rating scores.  The lists that we provide use the score to sort facilities, and we will be adding additional forms and reports as time provides.

Covid Cases in Nursing Homes

Yesterday we stumbled on a new CMS dataset which provides a weekly accounting for Covid-19 infections and deaths in nursing homes.  Strangely this report is not part of the more general set of nursing home reports that we currently retrieve.  The data is supposedly reported weekly though it is not clear when it is published.  The most recent date as of today if for the week ending March 14th.

Given the significant attention covid infections in nursing homes has gotten over the past year, we felt it was important to provide this information on our nursing home pages.  

As a positive note, the data (here is a visualization of the information) shows that Covid infection rates have dropped significantly in nursing homes across the country.

The data includes a long list of entries (120 in all) though not all of the fields are provided by each facility.  The most significant data shows weekly confirmed Covid cases and total confirmed Covid cases among nursing home residents and nursing home staff.  This information we are including in the data on individual nursing homes.

We’ll be looking at other ways to show the data too.