Many elderly people spend their final days in nursing homes. For them, high-quality end-of-life care is an important component of their overall care. Unfortunately, the Medicare hospice benefit—the primary source of palliative care coverage for Medicare beneficiaries—is a poor fit with the nursing home setting. We recommend creating a separate end-of-life Medicare benefit for nursing home residents based on documented need for services that neither requires physicians to certify a person's prognosis, nor requires beneficiaries to choose it or to agree to forgo curative care. Nursing homes would be paid directly for end-of-life care services and held accountable for their quality.
Huskamp, Haiden A., David G. Stevenson, Michael E. Chernew, and Joseph P. Newhouse. "A New Medicare End-Of-Life Benefit For Nursing Home Residents." Health Affairs 29.1 (January 2010): 130-135.