Hospice Care—Choosing Wisely

The elder care attorneys at Abraham and Bauer discuss varying levels of quality in hospice care.

Among its many attributes, Baltimore is one of the nation’s leaders in medicine. This reputation for high-quality health care extends to Baltimore’s hospice care providers as well. However, as detailed by a recent series of Washington Post articles, that experience is not universal.

This series highlights significant issues and a wide disparity of the level of care in the hospice industry. One of the stated statistics highlighted that at hundreds of hospices, more than a third of patients discontinue hospice services before death. This is a seemingly sure sign of dissatisfaction with the care and treatment provided. Medicare statistics further demonstrate that nearly 20 percent of hospices do not provide continuous nursing care or inpatient care for patients in crisis. A similar percentage represents the fact that hospices regularly fail to have a registered nurse visit within the final 48 hours of a patient’s life.

A central reason for the wide variation in care levels appears to be economic. Medicare, the largest source of industry revenue, pays $155 per day for hospice services. The more of that amount spent on patient care, the lower the profits for the hospice facility.

The main concern for the consumer is a lack of reliable information available to choose a hospice care provider. The federal government publishes consumer information regarding hospitals, nursing facilities and home health care agencies, but not hospice care providers. In 2010, Congress required that the government publish hospice quality data in an effort to rectify the lack of information. However, Medicare does not expect that information to be available until 2017.

In addition, hospice information often goes unpublished at the state level. When it is made available, the information can be difficult to find and even more difficult to comprehend. Further compounding the difficulties created by lack of funding, government inspections of hospice facilities typically take place once every six years.

Given the risk of receiving substandard care and a shortage of information, choosing a hospice for a loved one can be a challenge. Yet, there is some help available. As with any other business, personal referrals from friends or family can be a useful starting point. Several care-oriented websites also rate hospice services. However, be careful as in some instances these are paid listing services and may not be impartial. Certain states offer online comparison tools and, as part of its series, the Washington Post launched an online guide to hospice care that covers more than 3,000 facilities nationwide. While the Post admits the guide is not comprehensive, it could prove to be a useful and objective research tool.

For more information on hospice care or questions related to hospice care treatment, contact Richard Abraham at Abraham & Bauer, LLC.

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