The majority of hospices in the United States have at least one problem with their care and about 20% have at least one “serious deficiency,” according to a government watchdog investigation.

More than 80% of the 4,563 hospice centers that provide care to Medicare beneficiaries surveyed nationwide from 2012 to 2016 had at least one deficiency, according to a report this month from the Department of Health and Human Services Office of Inspector General. 

For the roughly 20% of hospice centers that had at least one “serious deficiency,” the report says their “capacity to furnish adequate care was substantially limited, or the health and safety of beneficiaries were in jeopardy.”

Among the most common non-serious deficiencies uncovered: “poor care planning, mismanagement of aide services, and inadequate assessments of beneficiaries,” the department said in a news release. “These failings – such as improperly vetting staff and inadequate quality control – can jeopardize beneficiaries’ safety and lead to poor care.”

The report noted problems such as the lack of supervision and proper training for staff and failures to obtain criminal background checks, monitor medication, treat severe wounds properly, stop patients from falling down and track infections. 

The number of serious deficiencies nearly quadrupled from 2012 to 2015, then slightly declined the following year.

At one hospice center mentioned in the report, a nurse didn’t tell a physician about a patient’s escalating pain or increasing use of pain medication. The patient was taking double the prescribed dose of fentanyl, a highly addictive drug.

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A secondary report was also released.

“Some beneficiaries have been seriously harmed when hospices provided poor care or failed to take action in cases of abuse,” the secondary report said.

The Office of the Inspector General suggested that safeguards for patients must be strengthened.

 The report recommends that the Centers for Medicare and Medicaid Services (CMS) seek authority to establish intermediate solutions for poor hospice performance. The CMS should have enforcement tools to protect its beneficiaries from harm, the secondary report says.

“Medicare beneficiaries who elect hospice care are an especially vulnerable population. They have the right to be free from abuse, neglect, mistreatment, and misappropriation of patient property,” the report says. “When hospices cause harm or fail to prevent or mitigate harm caused by others, beneficiaries are deprived of these basic rights.”

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