U.S. must boost hospice oversight, watchdog warns, citing serious lapses

Lawmakers and regulators must significantly improve the oversight of the burgeoning business of hospice care, a federal watchdog says. Its report came with two notable numbers: from 2012 through 2016, health inspectors cited 87% of the end-of-life care facilities for deficiencies, with 20% of them having lapses serious enough to endanger patients.

In one case cited by the Office of the Inspector General in the Department of Health and Human Services (HHS), a hospice patient had a deep, poorly treated pressure wound on the tailbone, apparent pain that caused grimacing and — in a crisis requiring a trip to the emergency room — a “maggot infestation’’ where a feeding tube entered his abdomen, the Washington Post reported.

The newspaper said inspectors also found “a patient whose pressure ulcers developed gangrene, resulting in an amputation; a patient whose injuries from an apparent sexual assault were missed and discovered only at a hospital; and another who did not receive appropriate medication and died in pain.”

These incidents were unacceptable and the direst among multiple problems found in hospices nationwide, the inspector general reported, calling on federal Medicare officials to toughen the regulation of what has become an $18 billion industry with 4,500 facilities. As the Washington Post reported of hospice care:

“Medicare pays for most hospice care in the United States … But Medicare’s oversight of hospice is not as strong as its oversight of nursing homes. The frequency of hospice inspections by state or private accreditation agencies increased from once every six years to once every three years in 2018. About 300 hospice providers, or nearly 20% of all hospices inspected in 2016, had a serious deficiency or a substantiated severe complaint, making them ‘poor performers,’ the [inspector general] report said. There are few requirements for hospice companies to alert Medicare when they detect violations. And when problems are discovered, Medicare has limited tools to discipline providers for neglecting or harming patients, even in cases of ‘immediate jeopardy.’ Other than removing them from the Medicare program, a step that is very rarely taken, Medicare has no ability to levy fines or other sanctions on poorly performing hospice providers, the report said. It also found fault with Medicare’s Web portal, Hospice Compare, which is supposed to help patients and families shop for hospice providers based on quality and other metrics. But Hospice Compare does not list hospice provider deficiencies or state inspection results.”

This is not good. In my practice, I see not only the harms that patients suffer while seeking medical services, but also the misery that can be inflicted on them and their loved ones due to nursing home neglect and abuse. It is, of course, impossible to predict with precision death’s timing, and when it is medically appropriate for patients and their loved ones to consider the alternatives of hospice and palliative care, both of which have provided welcome options to what may be prolonged, costly, invasive, and painful end-of-life care in hospitals or nursing homes.

But if patients and their loved ones seek peace, comfort, and compassion in the final days, lawmakers and regulators clearly have work to do on hospice oversight. This is a pressing need as the nation grays and increasing number of Americans will rely on this specialized care.

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