Hospice Medicare

Is current hospice care inadequate?

In recent years, demand for palliative rather than interventionist end-of-life in hospices has grown dramatically. More than a million patients each year use hospice facilities. In fact, in some cases terminally patients live longer in hospice than in more intensive care settings.

However, hospice are generally most attractive when they provide treatment if patients face some crisis. A recent article from the Washington Post, however, notes that many hospices are not providing sufficient treatment during these crisis.

But about one in six U.S. hospice agencies, serving more than 50,000 of the terminally ill, did not provide either form of crisis care to any of their patients in 2012, according to an analysis of millions of Medicare billing records.

The absence of such care suggests that some hospice outfits are stinting on nursing attention, according to hospice experts. Inspection and complaint records, meanwhile, depict the anguish of patients who have been left without care.

Some were tormented by pain. Others had breathing difficulties, with some unable to get an answer about why their oxygen tanks weren’t working. And some were compelled to leave their homes, formally drop hospice services and head by ambulance to the emergency room, a notoriously difficult place for the frail and dying.

Indeed, at 445 hospices, a third or more of patients died without having seen a skilled nurse in the 48 hours before their death, according to 2012 Medicare internal statistics obtained by The Post.

The trouble, in part, may be a matter of economic incentives posed by Medicare payment rates. Providing patients with “routine” levels of care, which typically includes semiweekly nursing visits, can be very profitable. But providing continuous bedside nursing care or inpatient care to needier patients can be a financial and logistical drain for small and mid-size agencies, hospice owners said.

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