{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,15]],"date-time":"2026-10-15T12:43:10Z","timestamp":1792068190874,"version":"4.4.0"},"reference-count":27,"publisher":"Wiley","issue":"1","license":[{"start":{"date-parts":[[2025,8,29]],"date-time":"2025-08-29T00:00:00Z","timestamp":1756425600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"funder":[{"DOI":"10.13039\/100000049","name":"National Institute on Aging","doi-asserted-by":"publisher","award":["K23 AG076866"],"award-info":[{"award-number":["K23 AG076866"]}],"id":[{"id":"10.13039\/100000049","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["agsjournals.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["J American Geriatrics Society"],"published-print":{"date-parts":[[2026,1]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:p>Hospitalized older adults with serious illness may be discharged to a skilled nursing facility (SNF) with the hope of improving strength to live independently and receive further disease\u2010directed treatment, or because it is one of the few insurance\u2010covered options for care that provides room and board coverage. For those that do not improve, discharge to a SNF can begin a cycle of costly care transitions between hospital, home with home health care, SNFs, and long\u2010term care facilities, leading to fragmented care and missed opportunities for discussions about preferences for care, illness understanding, and to address distressing symptoms. It can also lead to dying in the emergency room and other locations that are not consistent with patient wishes. In this article, we describe key policies that contribute to high\u2010cost, low\u2010value care near the end of life for older adults using the Medicare SNF benefit. With this foundation, we propose next steps to understand the scope of the problem better and offer solutions to improve care, including increasing palliative care delivery in SNFs and changes to the Medicare SNF benefit to improve hospice access and utilization for beneficiaries who currently experience multiple care transitions near the end of life.<\/jats:p>","DOI":"10.1111\/jgs.70067","type":"journal-article","created":{"date-parts":[[2025,8,29]],"date-time":"2025-08-29T13:39:13Z","timestamp":1756474753000},"page":"26-32","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":4,"title":["Rehab and Death: Improving End\u2010Of\u2010Life Care for Medicare Skilled Nursing Facility Beneficiaries"],"prefix":"10.1111","volume":"74","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-1674-316X","authenticated-orcid":false,"given":"Sarguni","family":"Singh","sequence":"first","affiliation":[{"name":"Division of Hospital Medicine, Department of Medicine University of Colorado School of Medicine  Aurora Colorado USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christian Davis","family":"Furman","sequence":"additional","affiliation":[{"name":"Divisions of Geriatric and Palliative Medicine Trager Institute, University of Louisville  Louisville Kentucky USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lynn A.","family":"Flint","sequence":"additional","affiliation":[{"name":"Division of Geriatrics University of California San Francisco School of Medicine  San Francisco California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joan","family":"Teno","sequence":"additional","affiliation":[{"name":"Health Services, Policy, and Practice Brown University School of Public Health  Providence Rhode Island USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2025,8,29]]},"reference":[{"key":"e_1_2_10_2_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMp1809354"},{"key":"e_1_2_10_3_1","doi-asserted-by":"publisher","DOI":"10.1111\/jgs.16128"},{"key":"e_1_2_10_4_1","doi-asserted-by":"publisher","DOI":"10.1111\/jgs.14891"},{"key":"e_1_2_10_5_1","doi-asserted-by":"publisher","DOI":"10.1377\/hlthaff.2018.05445"},{"key":"e_1_2_10_6_1","doi-asserted-by":"publisher","DOI":"10.1177\/009885881404000101"},{"key":"e_1_2_10_7_1","doi-asserted-by":"publisher","DOI":"10.1001\/archinternmed.2012.4451"},{"key":"e_1_2_10_8_1","doi-asserted-by":"publisher","DOI":"10.1097\/01.NAJ.0000694336.19444.5a"},{"key":"e_1_2_10_9_1","doi-asserted-by":"publisher","DOI":"10.1001\/jamainternmed.2022.4080"},{"key":"e_1_2_10_10_1","doi-asserted-by":"publisher","DOI":"10.1200\/OP.24.00197"},{"key":"e_1_2_10_11_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jamda.2015.05.011"},{"key":"e_1_2_10_12_1","doi-asserted-by":"publisher","DOI":"10.1177\/1054773819835015"},{"key":"e_1_2_10_13_1","unstructured":"\u201cProtecting Seniors by Improving Safety and Quality of Care in the Nation's Nursing Homes \u201dThe White House.2022."},{"key":"e_1_2_10_14_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jamda.2021.11.027"},{"key":"e_1_2_10_15_1","doi-asserted-by":"publisher","DOI":"10.1111\/jgs.17458"},{"key":"e_1_2_10_16_1","doi-asserted-by":"publisher","DOI":"10.1080\/08959420.2020.1745737"},{"key":"e_1_2_10_17_1","doi-asserted-by":"publisher","DOI":"10.1089\/jpm.2022.0413"},{"key":"e_1_2_10_18_1","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2018.8981"},{"key":"e_1_2_10_19_1","doi-asserted-by":"publisher","DOI":"10.1111\/jgs.15653"},{"key":"e_1_2_10_20_1","doi-asserted-by":"publisher","DOI":"10.1001\/jamahealthforum.2020.0718"},{"key":"e_1_2_10_21_1","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2016.16840"},{"key":"e_1_2_10_22_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMra1404684"},{"key":"e_1_2_10_23_1","doi-asserted-by":"publisher","DOI":"10.1377\/hlthaff.2023.00465"},{"key":"e_1_2_10_24_1","doi-asserted-by":"publisher","DOI":"10.1093\/ppar\/prad001"},{"key":"e_1_2_10_25_1","doi-asserted-by":"publisher","DOI":"10.3399\/bjgp13X673559"},{"key":"e_1_2_10_26_1","article-title":"Equity Through Episode\u2010Based Payment: Features of the Transforming Episode Accountability Model","author":"Liao J. 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