There are few circumstances more heartbreaking than watching someone you love suffer from a terminal illness or other end-of-life health challenges. Placing a loved one into hospice care is an act of compassion and trust. When the hospice care program breaks our trust, the impact on the injured party can be devastating. 

 

In this post from Tim Gilpin Law Office, we’re taking a closer look at how you can help prevent hospice care abuse and what you can do if it happens to someone you love. To learn more about hospice care abuse and other medical malpractice surrounding end-of-life issues, call Tim Gilpin and schedule a consultation. 

When Hospice Care Leads to Harm

According to the National Hospice and Palliative Care Organization, more than 1.55 million Medicare patients received hospice care in 2018 with an average lifetime length of stay of just over 89 days. In a pair reports by the U.S. Department of Health and Human Services Inspector General’s office, the HHS found that most U.S. hospice providers participating in Medicare demonstrated deficiencies in their quality of care. While the HHS is continuing to develop recommendations to help reduce the risk of harm to hospice patients, the issues of medical malpractice and hospice abuse remains serious risks for anyone with a loved one in hospice care. 

The Role of Hospice Care

As an individual faces end-of-life issues, the need for ongoing care with even the simplest daily needs compounds. As patients face the final stages of chronic or terminal health conditions, their health care needs become more about making them comfortable and helping them through their final days with as little pain as possible and providing other important types of support both for the patient and for their family. 

These are just some of the issues a good hospice care team will attend to:

• Pain management
• Medication management
• Symptom management
• Mental health care
• Emotional support
• Help with personal hygiene and other daily needs
• Respite for family caregivers
• Bereavement support

A good hospice care team may include physicians and nurse practitioners who specialize in gerontology and/or palliative care, support nurses, health aides, physical therapists, occupational therapists, mental health counselors, social workers, and clergy. 

Overall, the goal of a hospice care program is to make the transition through the patient’s end-of-life period as comfortable as possible, allowing the individual to die with dignity. Sadly, too many hospice providers fail in that obligation.

When Hospice Care Fails a Loved One

As outlined in the HHS reports, the reasons for hospice care abuse and other deficiencies are often complex with many related to economic pressures and benefits intrinsic to the U.S. healthcare system. These can lead to problems with staffing, poor or inadequate training, negligence of care, and even outright exploitation of patients.

These are some of the most common examples of how hospice providers can fail a palliative care patient: 

Medication errors

Medication errors under any circumstances could result in serious harm or loss of life. But for highly vulnerable hospice patients, medication errors can be even more impactful. A hospice care provider is responsible for administering the correct medication in the correct dose and monitoring the patient’s medication plan. Any mistake in that patient’s medication management is potentially medical malpractice. 

Caregiver neglect

Neglect of a hospice patient can take many forms. One that doesn’t receive nearly enough attention is undermedication. Hospice providers are responsible for helping patients manage their discomfort and symptoms. If a provider is undertreating pain or other symptoms that lead to a patient’s discomfort, this is a violation of their obligation to provide care for the patient. In some cases, this failure to properly medicate could even be tied to medication diversion. 

Another type of patient neglect is failure to provide proper wound management. When pressure ulcers (bedsores) are not properly managed, these conditions can become extremely painful and hasten a patient’s demise. Neglect can also mean failing to attend to a patient’s personal hygiene or provide the nutrition that patient needs. 

Hospice providers are also obligated to respond when a patient needs them. Failure to respond to a patient when he or she repeatedly calls for help may constitute an example of patient neglect even if the patient’s needs arise after normal business hours or when the provider is understaffed. 

Physical abuse

It goes without saying that anyone working with hospice patients is obligated to treat them with respect, patience, and care. Caregivers have no right to physically harm or injure a patient under any circumstances. Any time a provider pushes, hits, or inappropriately restrains a patient is unacceptable. 

Verbal, psychological, and emotional abuse

Verbal and emotional abuse are far more common than most people realize in hospice environments. A hospice caregiver should be emotionally and professionally prepared for the challenges of caring for a hospice patient without compromising their care. Humiliating a patient, verbally abusing them, or threatening them is unacceptable. Isolating that patient, causing them fear, or emotionally manipulating them are further examples of abusive behaviors. 

Financial abuse

Sadly, some caregivers will take advantage of a hospice patient’s vulnerable state to exploit them financially whether the guilty party is outright stealing the patient’s personal belongings or attempting to manipulate the patient into estate planning in their favor or giving them money. Some hospice providers will even take advantage of the patient and their family by committing fraud to overbill the patient or their insurance. All of these constitute financial abuse. 

Choosing a Hospice Provider

One of the best ways you can protect your loved one as they enter hospice is to do your research before choosing a provider. Don’t be afraid to schedule an interview with each potential hospice provider you’re considering. Here’s a list of questions to take with you:

1. Which individuals will be on my loved ones care team? 
2. What are their qualifications?
3. What are the provider’s hiring requirements? 
4. Are caregivers subjected to criminal background checks? 
5. How are they screened to ensure they can safely provide hospice care?
6. What kind of training do caregivers receive from the provider?
7. How does the provider minimize negligence, abuse, and other deficiencies?
8. Can we reach out to a caseworker at all times?
9. What is the process for handling concerns regarding a patient’s care?

Researching Your Choices

Don’t rush into choosing a hospice provider. Here are a few morethings you can do to make sure you’ve explored all of your options:

1. Ask friends, family, and medical professionals you trust for their experiences and suggestions.
2. Read the Medicare Hospice Booklet.
3. Look up Google and Facebook ratings for the provider you’re considering. 
4. Visit Hospice Compare to learn more about the providers available in your community. 

Developing a Hospice Plan of Care

Every hospice provider is legally required to develop an individualized care plan (POC) for each patient. It’s important to work with your hospice care provider to develop a plan of care that prioritizes your loved one’s safety, comfort, quality of life, and personal needs. As you go into the process, take some time to consider your loved one’s goals as well as your family’s concerns. And remember: hospice plans of care are meant to provide palliative care, not cure or heal a patient. 

According to the Center for Medicare and Medicaid Services (CMS), hospice plan of care deficiencies are some of the more common deficiencies among hospice care providers. These are some of the more common deficiencies CMS found surrounding POCs:

• Incomplete plans of care
• Plans of care were not individualized
• Inadequate documentation of visits
• Documentation of visits failed to reflect POC requirements
• Failure to update POCs

Be sure to ask for a copy of your loved one’s POC. Letting the provider know that you will be closely watching POC requirements can go a long way in holding providers responsible for these deficiencies. 

Reporting Hospice Deficiencies, Neglect, and Abuse

If possible, speak to your loved one regularly to ensure they are receiving the appropriate level of care including comfort, safety, and compassion. If you suspect any type of medical malpractice surrounding a hospice patient’s care, be sure to document everything and report it immediately to the appropriate authorities. 

Here are some things you can do:

• Speak with your hospice provider about your concerns, reporting any issues to the hospice administrator.
• Contact the Oklahoma State Department of Health. 
• Contact Oklahoma’s Adult Protective Services. 
• Call the local police if you suspect a crime has been committed. 
• Contact 1-800-MEDICARE to discuss your concerns. 
• Contact an attorney to discuss your loved one’s rights. 

Contact Attorney Tim Gilpin

Whether due to abuse, negligence, or other deficiencies, it your loved one is receiving anything less than the appropriate standard of care, you may have grounds for a medical malpractice case. Bringing a medical malpractice case against deficient or bad faith hospice providers can do more than just help your loved one regain their dignity — it can also help to ensure future patients don’t have to go through what your family and loved one has endured. 

To discuss your medical malpractice concerns with a seasoned, compassionate attorney, call Tim Gilpin today for your consultation.