Thank you Amy for your response. It was about time that someone got excited about my proposal. In fact, what I put together was a position that I was asked to take in a lecture about the pros and cons of having a hospice (or in our city, twenty hospices) co-manage a patient in the skilled nursing facility.
I work with a couple of facilities that have the resources to care for palliative patients without the frustrations and challenges that you mention. The physicians in those facilities are well-trained and comfortable handling the end-of-life care for elderly patients. It sounds as if in your area there are many deficits in care in the nursing home, let alone with a palliative to care of the residents.
My last two questions still remain. I do expect that changes in reimbursement will occur in the SNF and other settings. This will give the SNF a different opportunity to contract with a hospice within the context of a continuum of care where the experts in palliative care can work with patients. Bundling of payments has begun and will continue very quickly.
All of us need to be prepared so that our residents (patients) will be cared for with the comfort that they deserve.