GAO on Hospice

On December 12, 2022, the US Government Accountability Office issued a report that recommended that the Center for Medicare and Medicaid Services (CMS) expand all hospice abuse and neglect report requirements. These requirements will be reflected more in nursing homes and hospital reports. All hospice care providers will report all instances of suspected abuse and neglect right away, including suspected perpetrators who are not associated with hospice care providers. The Department of Health and Human Services did not agree or disagree with the GAO recommendation.

Current Hospice Policy

Currently, hospice care providers are required to report all abuse or neglect allegations to appropriate authorities. These include (1) “if the alleged perpetrator is affiliated with the hospice ” and (2) “after the hospice has verified it as abuse or neglect based on an internal investigation, which may take up to five days.”

Under the first requirement, hospice providers are not required to report any abuse or neglect that is suspected by an unaffiliated third-party member.  Many studies have shown that abuse in hospice level care occurs inside the home by family members rather than the hospice care provider or its affiliates. Compared to a hospital or nursing home setting, providers are required to report any suspected abuse or neglect, no matter who is involved.

Under the second requirement, reporting of suspected abuse and neglect can only occur after an internal investigation has occurred at hospice level care. This differs from hospitals and nursing homes; reporting must occur immediately after there is suspected abuse. Specifically, nursing homes and hospitals must report harm to the body within two hours of occurring and all other related abuse within 24 hours. This will allow CMS to initiate the investigation of their care and ensure the health and safety of their patients, even when they’re not under their care.

GAO’s Recommendation and Implications

               As stated above, GAO recommends that CMS require hospice care providers to report all suspected abuse and neglect immediately to the appropriate care provider. Though this would ultimately benefit the hospice care patient, this could lead to further implications for the care provider. Due to a hospice patient declining state, they are more subject to falls, bruising, and skin tearing.  Hospice care providers visit the patient and family less frequently compared to a nursing home or hospital setting. On the contrary, it is also important to note that frequent bruising may be more alarming when only seen a couple of times a week. Implementing this reporting system could possibly lead to over-reporting or wrongfully reporting suspected abuse and neglect. This could also create a divide between the patient, the patient’s family, and the hospice care provider, disrupting the patient and provider relationship. There is also a lack of suspected survey staff to investigate said reports.

Will implementing a requirement for hospice care providers to report subject abuse and neglect cause more harm than good? Will this requirement from the GAO advocate for the neglected patients under hospice care or ultimately damage the hospice care providers and drive a wedge between them and their families?