Is That Hospice Safe? Infrequent Inspections Mean It May Be Impossible to Know

Inspectors showed up at a hospice agency here in March 2012, and then issued what amounted to a 161-page catalogue of end-of-life neglect.

A woman dying of liver cancer, battling nausea and breathing difficulties, waited weeks for someone to drain fluid from her swelling abdomen and died still waiting, according to records. Another cancer patient had a feeding tube that oozed pus where it pierced his skin and did not actually reach his stomach. He had received no fluids from it for five days, emergency room doctors said. At the same time, a patient complaining about chest pain waited two days for a recorded visit and eventually was taken to a emergency room and diagnosed with pleurisy.

In all, the state health inspectors found treatment problems in the records for nine of 14 patients from early 2012.

The discoveries at the hospice, known as Expect Care, highlight how weaknesses in the inspection system can allow agonizing lapses­ in care for the terminally ill.

The typical hospice in the United States undergoes a full government inspection about once every six years, according to federal figures, making it one of the least-scrutinized areas of U.S. health care — even though about half of older Americans receive hospice care at the ends of their lives. By contrast, nursing homes are inspected about once a year, and home health agencies every three years.

Even as the U.S. hospice industry has grown rapidly, caring for some of society’s most vulnerable, the companies that provide hospice services are rarely reviewed for competency.

It is impossible to say precisely how many hospice companies might be cited for violations if there were more scrutiny, but a significant portion of them appear to be providing scant care, Medicare statistics and interviews show.

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Is That Hospice Safe?  Infrequent Inspections Mean It May Be Impossible to Know