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The concept of hospice is wonderful.  However, all hospices are not.
It is important to know about any hospice program where you or a loved one may be seeking care.

“Two Novus Doctors Sentenced to Combined 23 Years in Prison for Healthcare Fraud”
(U.S. Attorneys, Northern District of Texas — December 2, 2021)
“According to evidence presented at trial, the defendants helped Novus CEO Bradley Harris defraud Medicare by, among other things, illegally admitting patients who were not appropriate for hospice and submitting materially false claims for hospice services…
“Mr. Harris and the nurses used pre-signed prescription pads prepared by Dr. Gibbs, Dr. Hughes and other Novus doctors, to dispense medications like morphine to patients…
“These doctors allowed Bradley Harris — an accountant with no medical expertise — to dispense controlled substances like candy, with little or no medical oversight.”

“Choosing a Hospice: 16 Questions to Ask”
Until hospice quality data is readily and easily available to all of us, the experts at American Hospice Foundation have pulled together some tips for choosing the most appropriate hospice.

“Find a  hospice agency”
Search for hospice programs in your area.

“Senate Bill Would Extend Telehealth Flexibilities Beyond Pandemic”
(Hospice News — May 19, 2021)
A bipartisan group of U.S. Senators have introduced the Creating Opportunities Now for Necessary and Effective Care Technologies (CONNECT) for Health Act of 2021. If enacted the bill would expand Medicare coverage of telehealth service and make permanent flexibilities for virtual services implemented on a temporary basis during the COVID-19 pandemic.

It would permanently remove all geographic restrictions on telehealth services and expand originating sites to include the home and other sites….

Such services would include hospice telehealth, including permitting practitioners to recertify patients via telemedicine appointments rather than face-to-fact encounters.

“Hearing persists at end of life, brain waves of hospice patients show”
(Health24 — September 16, 2020}
In their last hours, many people become unresponsive.  However EEG data indicated that their awareness of sounds was similar to healthy people.  This suggests that they may still be aware of the presence of their loved ones, even though unconscious.

“HHS Inspector General Finds Serious Flaws in 20% of U.S. Hospice Programs”
(NPR — July 9, 2019)
“The Office of the Inspector General in the Department of Health and Human Services found that from 2012 through 2016, health care inspectors cited 87% of hospices for deficiencies.  And 20% of hospices had lapses serious enough to endanger patients….”
“We live in a time when we don’t even think about booking a hotel without checking its ratings and reviews.  Why do we demand less for hospices?”

“This doctor makes house calls to the terminally ill”
(Los Angeles Times — February 24, 2019)
As for hospice, Dorio’s prescription filled two pages.  Some highlights:
Far more government oversight.
Investigations into conflicts of interest and finder’s fees for doctors who refer patients to specific hospice agencies.
More crowd-sourced evaluations of hospice agencies.
Stricter requirements that hospice agencies are properly staffed, so patients don’t get neglected.

“Missed Visits, Uncontrolled Pain And Fraud: Report Says Hospice Lacks Oversight”
(Kaiser Health News — July 31, 2018)
Elderly patients spent over two weeks in uncontrolled pain or respiratory distress.  Acute care was rare on weekends….
These details appear in a report on hospice released Monday by a government watchdog agency calling on federal regulators to ramp up oversight of a booming industry that served 1.4 million Americans in 2016….
Just last October, the federal government reached a $75 million settlement with Vitas Hospice Services — a large for-profit chain owned by Chemed Corp. which also owns the Roto-Rooter plumbing company — to address allegations of fraudulent billing.

“‘No One Is Coming’: Hospice Patients Abandoned At Death’s Door”
(California Healthline — October 26, 2017)
The hospice care people expect — and sign up for — sometimes disappears when they need it most.  Families across the country, from Alaska to Appalachia, have called for help in times of crisis and been met with delays, no-shows and unanswered calls…. Only in rare cases were hospices punished for providing poor care, the investigation showed.

“Hospice in Crisis”
(Politico — September 27, 2017)
The most important end-of-life movement in a generation struggles in an era of changing families and prolonged deaths.
Nowadays, dying itself has changed….That makes it harder to prognosticate just how much time someone may have left to live.  Given that hospice care is generally available only to people likely to die within six months, prognosticating is important.  Even to the practiced medical eye, it’s not always clear exactly when a patient is crossing that almost imperceptible line between “very sick” and “dying/”

“International Association for Hospice and Palliative Care Position Statement: Euthanasia and Physician-Assisted Suicide”
(Journal of Palliative Medicine — Volume 21, Number 1, 2017)
In countries and states where euthanasia and/or PAS are legal, IAHPC agrees that palliative care units should not be responsible for overseeing or administering these practices. The law or policies should include provisions so that any health professional who objects must be allowed to deny participating.

“FBI: Texas Hospice Boss Texted Nurses Execution Orders for Patients”
(Source: Daily Beast — March 31, 2016)
On at least four occasions, the affidavit says, Harris instructed nurses to administer overdoses to patients who had “been on the hospice service too long.”
In one instance, Harris allegedly texted a nurse to dispatch a lingerer “by increasing the patient’s medication dosage to approximately four times the maximum allowed.”

“Frisco hospice owner urged nurses to overdose patients so they would die quicker, FBI says”
(Source: Dallas Morning News — TX — March 29, 2015)
The owner of a Frisco medical company regularly directed nurses to overdose hospice patients with drugs such as morphine to speed up their deaths and maximize profits and sent text messages like, “You need to make this patient go bye-bye,” an FBI agent wrote in an affidavit for a search warrant obtained by NBC 5.
More on Texas

“As more hospices enroll patients who aren’t dying, questions about lethal doses arise”
(Washington Post)
His death certificate, which was signed by the hospice doctor, listed the cause as “renal cell carcinoma” or kidney cancer.  But the doctor had never examined Coffey, his family said, and medical records from just a few weeks earlier do not mention it.

“Assisted suicide compromise: Column”
(USA Today — November 13, 2014)
Give terminally ill patients both hope and hospice.
Rather than shout at each other, both sides of the assisted suicide divide should get enthusiastically behind this health care change:  Allow the terminally ill to enter hospice care without having to give up life-extending or curative treatments.

“As more hospices enroll patients who aren’t dying, questions about lethal doses arise”
(Washington Post — August 21, 2014)
The hospice industry is booming, but concerns are rising about treatments for patients who aren’t near death.

“Getting Hospice Care Shouldn’t Have To Mean Giving Up”
(NPR — July 29, 2014)
Now an experimental project, set to enroll 30,000 people over the next few years, will allow some hospice-eligible Medicare patients to get treatment for the disease and hospice care at the same time.

“Is that hospice safe?  Infrequent inspections mean it may be impossible to know”
(Washington Post — June 26, 2014)
Even the National Hospice and Palliative Care Organization, a Washington-based trade group, has advocated for more frequent inspections.  “There are two kinds of hospices in America: the ones that get it right, and those that should be out of business,” Don Schumacher, president of the NHPCO, said in a statement.

“How Dying Became A Multibillion-Dollar Industry”
(Huffington Post — June 19, 2014)
Evelyn Maples’ last day as a hospice patient wasn’t anything like her family imagined when the nurse from Vitas Healthcare first pitched the service two months before….The average U.S. hospice has not undergone a full inspection in more than 4.5 years….The most difficult part of Maples’ experience to evaluate concerns her medications.

“End of ‘Abandon All Hope’ Hospice Model?”
(National Review Online — May 20, 2014)
A new program from the Centers for Medicare and Medicaid Services may remove a barrier that makes patients hesitate to opt for hospice care near the end of life….A new Medicare Care Choices Model will soon offer an option for Medicare beneficiaries to receive palliative care services from certain hospices while still receiving treatment from curative care providers.

“Terminal neglect? How some hospices decline to treat the dying”
(Washington Post — May 3, 2014)
For more than a million patients every year, the burgeoning U.S. hospice industry offers the possibility of a peaceful death, typically at home. But that promise depends upon patients getting the medical attention they need in a crisis…..
Hospices are among the least inspected organizations in the U.S. health-care system, with most operating for years before an inspector calls.

“Hospice workers struggle on front lines of physician-assisted death laws”
(Medical Xpress — July 22, 2013)
A recent study of 33 hospice programs in Washington state found that laws that allow physician-assisted suicide in the Pacific Northwest have provisions to protect the rights of patients, doctors and even the state, but don’t consider the professionals most often on the front lines of this divisive issue — hospice workers who provide end-of-life care.