Hospice care is intended to provide crucial emotional and medical support to people nearing the end of life. But according to a new report from the Department of Health and Human Services, Medicare-funded hospice providers often fail to meet patient and caregiver needs.
The report, released Tuesday, identifies “significant vulnerabilities” in the hospice system, which provides care in a variety of settings, including homes, nursing facilities, hospitals and hospice facilities.
Pain management, for example, is a critical aspect of end-of-life care, but the report says hospice providers do not always provide ways needed to manage pain and other symptoms. In one case, the report notes, a 101-year-old man with dementia had “uncontrolled” pain for his 16-day stay in hospice. The facility failed to give him the special mattress he required for more than a week. His pain medication was not changed until the last day of his stay.
And care often falters on the weekends. Though Medicare requires providers make services available as needed, the report found that the number of hours of care drops significantly on weekends. Hospices were also more likely to provide inpatient care (for pain or other symptoms that cannot be managed at home) on weekdays. The report notes it's “critical that beneficiaries receive it when they need it.”
Once a patient starts receiving hospice care, Medicare no longer pays to treat the illness. One woman, according to the report, was falsely told that she could remain on a liver transplant list after choosing hospice care. She was removed from the transplant list but later stopped hospice care so that she could be reinstated.
The report also found many instances of fraud ranging from improper billing (which cost Medicare hundreds of millions of dollars) to phony enrollment schemes. In one case, a New York hospice billed Medicare for one month of continuous home care occurring after the beneficiary had died.
To fight fraud and improve care quality, the report calls on the Centers for Medicare & Medicaid Services to strengthen the existing compliance process, improve oversight and do more to keep beneficiaries and caregivers informed. “More must be done,” the report concludes, “to protect Medicare beneficiaries and the integrity of the program.”