Document Type


Publication Date



health care policy, end-of-life care, nursing homes, hospice


Reprinted by permission of the American Society of Law, Medicine and Ethics, © 2005. Published in Journal of Law, Medicine & Ethics, v. 33, no. 2, summer 2005.


This article examines current health care policies and government practices that deter appropriate end-of-life care, focusing on the use of hospice services for dying nursing home patients. The authors conclude that hospice and nursing home regulations, reimbursement for hospice and nursing homes, and enforcement of the fraud and abuse rules collude to “chill” utilization of hospice by nursing homes and result in inadequate end-of-life care for many nursing home patients. They argue that these policies and practices have at their roots a number of questionable assumptions and call for a shift in existing paradigms affecting care to this group and a realigning of incentives among these various government policies to achieve consistent policy goals.

Publication Citation

33 Journal of Law, Medicine & Ethics 294 (2005).


Health Law and Policy