A new medicare end-of-life benefit for nursing home residents.

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.