Hospice care is supposed to help terminally ill patients maintain their quality of life at the end of their life- but two new government reports find that serious problems in some hospices may be actually causing harm to hospice patients. The reports propose that additional safeguards are needed.
Medicare provides a comprehensive hospice benefit that covers any care that is reasonable and necessary for easing the course of a terminal illness. Most hospice care is provided in the home or in a nursing home. State agencies or private contractors survey hospices to make sure they comply with federal regulations. If a hospice fails to meet a standard- the surveyor cites the hospice with a deficiency.
A pair of reports by the U.S. Department of Health and Human Services’ Office of Inspector General (OIG) found that from 2012 through 2016- more than 80 percent of hospices surveyed had at least one deficiency and one in five had a deficiency serious enough to harm patients. About 300 hospices were identified as “poor performers” and 40 had a history of serious deficiencies.
The reports found that the most common types of deficiencies involved poor care planning- mismanagement of aide services- and inadequate assessments of beneficiaries. Some of the most serious problems that were found included a beneficiary who developed pressure ulcers on both heels- which worsened and developed into gangrene- requiring amputation of one leg. Another beneficiary developed maggots around his feeding tube insertion site. Both of these beneficiaries had to be hospitalized- which hospice is meant to prevent.
Meanwhile- the OIG found that it is hard for consumers to learn about which hospices are doing a good job. The Centers for Medicare and Medicaid Services (CMS) launched the Hospice Compare website in 2017- but the site does not include information from the surveyors’ reports. Hospices also do not have as strong reporting requirements as nursing homes. In addition- CMS has limited ability to discipline hospices other than to drop the hospice from Medicare.
The reports provide a number of recommendations to CMS to improve monitoring of hospices- including the following:
- Expanding the data that surveying organizations report to CMS and using these data to strengthen its oversight of hospices
- Taking steps to include the survey reports on Hospice Compare
- Educating hospices about common deficiencies and those that pose particular risks to beneficiaries
- Increasing oversight of hospices with a history of serious deficiencies
- Strengthening requirements for hospices to report abuse- neglect- and other harm
- Ensuring that hospices are educating their staff to recognize signs of abuse- neglect- and other harm
- Improving and making user-friendly the process for beneficiaries and caregivers to make complaints.