Aligning Policy Incentives to Advance Palliative Care in Nursing Homes

Principal Investigator(s)

Nicholas G. Castle, PhD, MHA


  • Robert M. Arnold, MD

Palliative care practices have diffused into acute care settings, but are less prevalent in nursing homes. The potential benefits of palliative care in nursing home settings have received little attention from researchers and policymakers. In this study, Drs. Nick Castle and Bob Arnold are examining the misaligned incentives in Medicare, Medicaid and private coverage and potential cost savings and quality implications of the delivery of palliative care in nursing homes. The nursing home resident population includes many people living with serious illness, for which palliative care may optimize care and improve their quality of life. However, reimbursement for palliative care in nursing homes provides little incentive to provide this care. Thus, it is not clear that a tenable business case for providing palliative care exists. The study is exploring three aspects of palliative care in nursing homes:

  1. A case study of costs and potential cost savings of palliative care;
  2. The conflicting reimbursement incentives between payors;
  3. A simulation of the potential cost savings applied to nationally representative groups of nursing homes with varying policy, resident, and payor mixes.