Nursing Home Abuse & Hospice Care

Protecting Seniors in Hospice Care

Nursing home abuse is a prevalent and increasingly pressing issue. With a rising number of seniors entering nursing homes, these facilities are under increasing pressure to provide adequate care, and factors such as stress, understaffing, and poor staff screening can lead to staff abuse of elder residents. Family members and friends can also contribute to the abuse of their elderly loved ones.

In addition to these common cases of elder abuse, one often-forgotten potential source of turbulence in a nursing home is that of hospice care.

What is hospice care?

Hospice care is intended to reduce the stresses at the end of life. Once patients are diagnosed with life-limiting illnesses that give them than less six months to live, there is a shift away from curing and a shift towards caring. The focus turns to enjoying their remaining time with friends and family. These seniors are given the chance to pass away pain-free and with dignity.

Hospice care is a team-oriented effort to provide expert medical care, proper pain management, therapy services, and emotional and spiritual support to suit the patient’s unique needs and desires. Hospice care is intended to help people reflect on life’s happier moments with friends and family, and to come to peaceful terms with death.

Hospice care involves a team of individuals looking to provide quality care, including:

  • Personal physicians
  • Hospice physicians
  • Nurses and health aides
  • Social workers
  • Clergy and other spiritual counselors
  • Speech, physical, occupational therapists
  • Other volunteers

Hospice care is shown to be effective, as only 20% of hospice patients report depression, compared to 50% of nursing home patients.

Unfortunately, all of this can be undone by improper hospice care. The Hospice care industry is fairly unregulated, with only half of states require training for workers. In fact, only 16% of hospice care companies test for any knowledge of providing care to seniors.

Facts about Hospice Care

Hospice care is covered under Medicaid, Medicare, HMOs, and most private insurance plans, meaning most seniors are financially eligible for hospice care. There are over 6,000 hospice care agencies in the United States. As of 2014, 1.7 million Americans received hospice care, which was a 21% increase from only 4 years prior in 2010.

In 2014, the median length of service of hospice care was 17.4 days, while the average length was 72.6 days.

66% of hospice care takes place in the patients’ homes, including 41.7% who receive care in their private residence. 17.9% of patients receive hospice care from their nursing home.

Between 1999 and 2006, the rate of residents requiring hospice care from a nursing home increased from 14% to 33.1%, which is more than a twofold increase, largely due to an aging population that requires more care for chronic, long-term illnesses.

Hospice Care Abuse in Nursing Homes

As over one in three nursing home residents receive hospice care at some point in their stay, it’s important to examine the potential for hospice care abuse. As hospice care workers are rarely screened for criminal records or tested for their ability to provide proper care, the door is opened for risk of abuse.

Many seniors who receive hospice care in nursing homes have no support networks and rely heavily on their aides. A heavy dependency on these aides puts the patient in a vulnerable situation. In some cases, aides are simply not qualified enough to provide services for the elderly, and the lack of attentive care can lead to premature death or other unintended consequences.

In more intentional cases, there are instances where aides physically or emotionally abuse the seniors they are supposed to be caring for. There are also many incidents where hospice care aides will form a close, personal bond or even a fabricated romantic relationship with the terminally ill patient with the explicit purpose of gaining control of their finances. Patients with dementia are especially vulnerable to this form of abuse.

Financial Fraud Between Hospice Care and Nursing Homes

The relationships between nursing homes and hospices are highly vulnerable to fraud. Most nursing homes prefer to have an exclusive relationship with a single hospice care provider. This way, it’s easier to coordinate care for all patients, screen the hospice caregivers who enter the residence, and ensure even care across the board.

Unfortunately, this introduces the possibility of financial fraud. The large pool of patients in a nursing home can be extremely lucrative to a hospice care provider, and they will sometimes pay an under-the-table fee to the nursing home in order to obtain the exclusive rights to the home.

Nursing home patients are especially valuable to hospice care providers for a variety of reasons, including:

  • Nursing homes have a large number of patients in one place, meaning less staff is required to treat patients, and less travel costs between locations.
  • Patients in nursing homes typically have longer stays in hospice care, meaning more profit per patient.
  • Hospice care providers typically receive a flat fee per nursing home patient, rather than payments for their specific care.
  • Patients in nursing homes typically receive less care from a hospice provider from those not in nursing homes, which means more profit per patient.

When nursing home patients become financially beneficial commodities rather than seniors with special needs, they are at increased risk for abuse. Any suspected cases of financial fraud should be reported to the Office of Investigations of the Office of Inspector General, U.S. Department of Health and Human Services.

Before choosing a nursing home, be sure to inquire about the hospice care arrangement at the home. Ask questions like:

  • Who provides hospice care at the home?
  • Is there a range of options or a single provider?
  • How does the nursing home screen hospice care workers?
  • Are criminal background checks performed?
  • How would dissatisfaction with the hospice care provider be handled?
  • What are the hiring requirements of the hospice care provider?

References

  1. http://www.aarp.org/home-family/caregiving/info-2015/elder-abuse-assisted-living.html
  2. http://www.nhpco.org/sites/default/files/public/Statistics_Research/2015_Facts_Figures.pdf
  3. https://oig.hhs.gov/fraud/docs/alertsandbulletins/hospice.pdf
  4. http://www.cdc.gov/nchs/data/series/sr_03/sr03_038.pdf
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Dr. Christine Traxler

Christine Traxler, MD is a retired family practice physician, graduate of the University of Minnesota School of Medicine in 1986, and freelance writer, having worked with patients in rural Minnesota for two decades. She has written several books on medical topics and currently resides in Minneapolis, MN, where she works as a freelance writer on medical topics.

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