This may seem like a bit of a political rant that is only tangentially related to senior living but . . . here goes. A few days ago I read the last article in a three part series about hospice care published in the Washington Post titled Rising rates of hospice discharge in U.S. raise questions about quality of care and it made my blood boil.
Hospice as a Business
Providing hospice care can be a very lucrative business. Abusing the system (which means abusing the elders it serves) can make it even more lucrative. In order for an individual to receive hospice care, covered by Medicare, they must be diagnosed as having fewer than six months to live. The article makes some obvious points about hospice:
- When individuals enter hospice care their need for services is typically lower at the beginning than in the last few weeks and days before death.
- The further from death an individual begins hospice treatment the more profitable it is for the hospice agency.
- The healthier an individual on hospice, the lower the level of services needed, which means higher profits for the hospice agency.
- Figuring out when someone is six months from death is a very subjective process.
- On occasion, some hospice care recipients legitimately either take longer than six months to die or just plain defy medical odds and get better.
Hospice Abusing Elders . . . and the rest of us
One of the big challenges of a massive system like Medicare is that it is very difficult to control costs and fraud. So difficult, in fact, that most people who defraud the system make hundreds to millions of dollars and never get caught. When they do get caught the penalties are not sufficient to be much of a deterrent. I find myself thinking maybe the death penalty would be the right incentive . . . just kidding . . . sort of! According to the article there are two things happening
- There is a huge increase in the number of individuals who are being discharged from hospice. This likely means a couple of things: 1) That a significant number of individuals are being diagnosed as having less than six months to live when, in fact, that diagnosis was made only to open the hospice cash flow spigot. 2) As individuals are getting nearer to end of life, the quality of care deteriorates to the point that patients opt out of the hospice program at the time they need it most.
- In the last few weeks of life patients are being essentially forced off hospice care, often dumping them back into acute hospitals as a way to save the hospice companies the high costs of late stage care. This defeats every intended benefit of the Medicare hospice program: neither pain, suffering or money is saved.
These practices not only rip off the Federal government, your tax money and mine, they mean that residents are either being subjected to powerful drugs when they shouldn't be or are not getting the services they most need in those last days.
Senior Living and Hospice Care
Hospice care has become an important part of senior living. It shifts some of the care cost for residents to the hospice and it allows residents to have longer lengths of stay. While good for the senior living community, it is also really good for residents, allowing them to spend their last weeks and days in a familiar, comfortable setting and, at the same time, to receive the pain medication needed to make their passing relatively painless. As an industry we have an obligation to vet the hospices that provide services to our residents. We need to refuse admittance to bad providers. Even more, we need to report those bad providers to the Office of the Inspector General. What has your hospice experience been like? Steve Moran
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