Preparing Americans for Death Lets Hospices Neglect End of Life

With his mother wheezing and losing consciousness in a California nursing home, Robert Rogers wanted her moved to a hospital. Vitas Healthcare, her hospice provider, said that wasn’t in the plan.

“Our job is not to prepare them to live,” a Vitas nurse told Rogers on the phone, according to a deposition he gave in April. “Our job is to prepare them to die.”

Rogers called 911. At the hospital, an emergency-room doctor removed 11 maggots from an open wound on his mother’s big toe. Five days later, in September 2008, 91-year-old Thelma Covington died of a sepsis infection brought on by gangrene in her toe and poor circulation, her death certificate said.

Rogers is suing Vitas, a unit of Cincinnati-based Chemed Corp. (CHE), in a California court for alleged elder abuse and wrongful death. Vitas, the biggest company in hospice care, has denied negligence and said that Covington and Rogers knew the risk involved in entering hospice. Ninety-five percent of Vitas care gets positive family ratings in surveys, said Kal Mistry, a company spokeswoman.

As hospice care has evolved from its charitable roots into a $14 billion business run mostly for profit, patients like Covington and their families have paid a steep price, according to lawsuits and federal investigations. Providers have been accused of boosting their revenues with patients who aren’t near death and not eligible for hospice -- people healthy enough to live a long time with traditional medical care. In hospices, patients give up their rights to “curative” measures because they are presumed to be futile.

Widespread Neglect
“By admitting these folks to hospice, they are denied access to routine medical and rehabilitative care that they need to extend and improve their lives,” said Cristen Krebs, executive director of Catholic Hospice of Pittsburgh, a non- profit. “A vulnerable and voiceless population is preyed upon for money.”

At the same time, patients are being neglected, according to the claims in the lawsuits, government court filings and interviews with more than 30 people who have worked in the industry or had relatives in hospice. In 2009, a Medicare oversight report found nearly a third of hospice patients were not getting services in care plans that describe the treatment and visits providers promise to give them.

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Preparing Americans for Dealth Lets For-Profit Hospices Neglect End of Life