PART IX: Hospice | October 19, 2014
Barbara DeWaters received such good care from Hospice of Southern Maine, some family members thought it was better than end-of-life care they had experienced elsewhere.
Rick DeWaters’ wife compared his mother’s care to the hospice services her father received a few years ago in New York.
“She asked me, ‘Why didn’t we get all these services?’ ” said Rick DeWaters, the oldest of Barbara DeWaters’ five children. “I really don’t know. I think a lot might have to do with awareness. You have to look into it and find out what’s available.”
Unfortunately, there’s no easy way to select a hospice agency, and ensuring quality end-of-life care requires consumers to be effective and knowledgeable advocates for their own interests, as they would when purchasing any services.
As demand and use of Medicare-funded hospice programs skyrocket, so does the potential for waste, fraud and abuse that was exposed in recent national news reports. But it may be difficult for consumers to choose among various nonprofit and for-profit hospice providers, especially amid the confusion and worry that often follow a terminal diagnosis.
The Centers for Medicare & Medicaid Services requires certified hospice providers to explain all available services and deliver them as necessary according to a doctor-approved care plan, including bereavement counseling for loved ones after a patient dies.
If they fail to offer or provide services as required, hospice agencies risk losing Medicare funding or certification. Problems can range from failing to offer chaplain services to enrolling patients who aren’t dying in order to collect the $155-a-day hospice fees.
Some say there’s no cause for alarm in Maine. Kandyce Powell, head of the Maine Hospice Council & Center for End-of-Life Care, said there’s little potential for widespread waste, fraud or abuse here because Maine has relatively few hospice providers – 19 Medicare-certified and seven volunteer programs – and because state inspectors monitor them closely.
Indeed, Maine falls below the national average on several Medicare hospice measures that can flag problems, including length of care (62 days in Maine vs. 71 days in the U.S.), payment per beneficiary ($10,075 in Maine vs. $11,842 in the U.S.) and percentage of patients discharged alive (10.9 in Maine vs. 13 in the U.S.), according to Medicare data compiled by Hospice Analytics.
The Centers for Medicare & Medicaid Services and the Maine Department of Health and Human Services monitor hospice providers with regular certification surveys, which Congress decided in September should happen every three years instead of every 6.5 years. But it’s unclear whether CMS will be able to increase oversight that has been flagging for decades.
A 2013 study by the federal DHHS’s Office of the Inspector General found hospice agencies in several states that hadn’t been surveyed in more than a decade and at least one agency that operated for 22 years without a survey.
Maine was ahead of the curve as one of the first states to adopt licensing regulations that require inspections every two or three years. Like Medicare certification surveys, licensing inspections review hospice records to make sure that employees are properly screened and trained, and that services are provided and documented to meet Medicare standards.
But these reviews have a limited scope and the resulting reports can be misleading and confusing, largely because they tend to focus on an agency’s attention to paperwork and policy guidelines rather than what happens in the field.
Most hospice agencies in Maine have been cited for deficiencies at one time or another in the last decade, according to state and federal reports provided to the Portland Press Herald/Maine Sunday Telegram under Freedom of Access Act requests.
Typical deficiencies included an agency’s failure to document criminal background checks on employees; a social worker’s substitution of a phone call for a home visit; and a hospice aide missing multiple home visits altogether. In many cases, however, it’s unclear whether a policy or patient’s need wasn’t met or simply wasn’t documented.
After deficiencies are found, an agency must submit a correction plan that wins the inspector’s approval in order to be relicensed or recertified, said Tammy Steuber, paralegal at the state’s licensing division.
The process might not sound sufficiently punitive, but most agencies take it very seriously because they could be forced to return Medicare payments for disputed services or lose their certification.
“Whenever we have deficiencies, they are taken seriously and acted on immediately” said Elaine Brady, a founder, board member and former interim executive director of Hospice of Southern Maine.
Part IX: Hospice
End-of-life care gave 92-year-old Barbara DeWaters the freedom to meet her death with dignity, surrounded by loved ones in a place she cherished. Will aging Mainers like her get the same medical and emotional support as demand for Medicare-funded hospice services skyrockets?
Part IX: Hospice
As Sussman House prepares to open in Rockport, providing close-to-home end-of-life care to Midcoast residents, two more projects are in development, one near Bangor and another in Aroostook County.