Hospice: People Beware

(This is the third of several articles dealing with protecting the elderly and infirm).

When a loved one is nearing the end of life, families are faced with many stressful issues, especially how to make their last days as pain free and comfortable as possible.

To meet those needs, the more than 4,000 hospice care agencies throughout the country promise to provide terminally ill individuals with physical, psychological, spiritual, and emotional support.

In the majority of cases they do just that, either for people in-facility, or the other half who prefer to be cared for at home.

But there’s a dark side. Many agencies function as ruthless businesses defrauding the government and mistreating those who need care and their families.

Families across the country who have called for help in times of crisis have been met with delays, no-shows and unanswered calls according to a study conducted by Kaiser Health News and published in Time magazine last October.

The article was entitled: ‘No One is Coming:’ Investigation Reveals Hospices Abandon Patients at Death’s Door.

Investigation Reveals Neglect, Abuse, and Fraud

The investigation analyzed 20,000 government inspection records, revealing that missed visits and neglect are common for people dying at home. Families or caregivers have filed more than 3,200 complaints in the past five years.

Those complaints led government inspectors to find problems at 759 hospices, with more than half cited for missing visits or other services they had promised to provide.

Revealed in another account is one of the worst examples of abuse that involved the owner of a North Texas agency who regularly directed nurses to give their residents overdoses of drugs such as morphine to speed up their deaths and maximize profits.

He also directed another employee to increase a patient’s medication to four-times the maximum allowed with a text message reading: “You need to make this patient go bye-bye.”

Other examples of fraud and abuse include:

  • Reducing the frequency of Home Health Aide (HHA) and Registered Nurse (RN) visits to a level that does not meet the patient’s needs.
  • Skimping on pain medications.
  • Refusing to provide oxygen, even though the family requests it. 
  • During a crisis, hospices can refuse to provide continuous around the clock nursing care in a patient’s home.
  • Asking patients and families to pay out of their own pocket for services that are being—or will be—paid by Medicare, Medicaid, the U.S. Department of Veteran Affairs, or private insurance.

Unbelievably, it was rare for any of the hospice agencies cited in the study to be punished for their actions.

Hospice providers, which serve 1.6 million people annually, receive $16 billion a year from Medicare.

To be eligible for hospice care, people must be assumed to have six months or less to live and agree to forego Medicare coverage for curative treatment. However it needs to be pointed out that diseases and conditions that are treatable could be considered terminal if the individual does not receive the appropriate medication. In other words, hospice is intended to help people and their families cope with the dying process. It is not designed to cure underlying illnesses.

After enrolling, an individualized written plan (Plan of Care, or POC) must be established and periodically reviewed by the attending physician and medical director. 

All hospice services must be reasonable and necessary for the palliation and management of the terminal illness, as well as related conditions. Palliative care is primarily intended to make people with a terminal diagnosis more comfortable, especially by controlling pain.

However, even that process can be abused. In some cases, hospice workers have secretly given lethal doses of pain medication to speed death, while the family is under the impression the treatment is only to help make the person more comfortable. 

“Given these inexcusable examples of abuse, I urge any family considering hospice care for a loved one to carefully review the regulations, and research the hospice being considered,” said GRTL President Ricardo Davis.

Helpful information can be found at the Hospice Foundation of America: https://hospicefoundation.org/ and the Hospice Patients Alliance: http://www.hospicepatients.org/.

Sources: time.com; nbcdfw.com; hospicepatients.org.

By Wayne DuBois
Georgia Right to Life
Media Relations Advisor