Heather10 Asked September 2018
HHS Inspector General's Report Finds Flaws And Fraud In U.S. Hospice Care! How can we protect our elderly relatives?
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www.npr.org/sections/health-shots/2018/07/31/634075540/hhs-inspector-generals-report-finds-flaws-and-fraud-in-u-s-hospice-care
A federal report published Tuesday synthesized patient and Medicare payment data going back to 2005 and found that, while patients generally can count on hospice to relieve their suffering, some hospice providers are bilking Medicare and neglecting patients.
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I am familiar with Reinhardts work. Reinhardt, advocated for Hospital pricing and transparency, drug pricing etc, and quality of care through a merit based system.
I agree 100 percent with him. I think he would have agreed with me. Quality of care is important and vigilance is the key to quality care as well as pay for performance.
We can ensure quality of care through vigilance and reporting of misbehavior.
To report misbehavior we must record and document it. Hence my advice to stay vigilant and alert.
Some of the SEEMINGLY sweetest hospice workers have been found to commit the most egregious acts, too.
So it's important to not be easily fooled by a workers sweet demeanor.
Personality disordered people like psychopaths and sociopaths are excellent actors and can convince the gullible of their goodness, even when they are not good people.
For those who are not familiar with Reinhardt's work, here is a Wikipedia link:
https://en.wikipedia.org/wiki/Uwe_Reinhardt
And and here is an excerpt from the link:
" In 2003, Reinhardt, along with 14 other prominent health policy experts and private health care industry leaders, signed an open letter arguing that Medicare should lead the U.S. health care industry in paying for performance by tying financial reimbursement to quality measures.
Reinhardt's work on health care spending includes his argument that the aging of the U.S. population is not the primary cause of the growth in U.S. health care spending. "
I agree the article is not reflective of the real situation, based on court cases filed across the USA.
In that sense it is cherry picked because the situation is far worse and not described realistically in the article.
I have in the past posted other information and links in other postings.
I have no objection to real change to Hospice care. That is my point. These places need a major overhaul, more funds, etc., less fraud and neglect and fewer lackadaisical, horrible workers.
You are asking the wrong person your question, when you ask: "Then what?"
I wish I had an answer to the 21 trillion in national debt. Do you have a solution. If so I am all ears.
My main focus is ensuring that people ensure their elders are being properly cared for in these facilities through vigilance and reporting to appropriate authorities and agencies.
And that is mainly because I do not have an intelligent, workable solution to the USA debt issue.
Implementing his viewpoint & frameworks of how to do health economics in the US would be where to start imho.
what you’ve posted are very Cherry Picked imo.
And imo not reflective overall of what OIG found & of concern. OIG reports are very much done to be used proactively by federal agencies to be able to do spending projections based on real data and then adjusting federal $ to be paid for programs based on these. OIG reports are required on items under federal mandatory budgeting. Like for SS and MediCARE.
For this OIG report - my take on it as an old health planner who did Certificate of Need workups - the focus was the significant increase in Medicare hospice benefit payments within Medicare budget and the costs of hospice for sustainability & in particular shifting of payments into higher category (inpatient level 1-4) without parallel caps monitoring. The bad actors stories were just a part of the report.
It is a warning report by OIG to CMS.
What I’d be more worried about is Seema Verma - the DHHS CMS Administrator - rejection of almost all the OIGs suggestions. What wasn’t rejected was claims based specificity, which means to me that eligibility is going to be very much tighter.... like they better be overwhelmingly terminal in days & if not then off hospice. The national debt is like 21 Trillion. Rejecting real changes to hospice just increases Medicare costs & causes it to collapse & eventually gives Congress reasons to stop hospice entirely as a Medicare benefit as that $ will be needed to pay off on some of that 21 Trillion and going up every day debt. Then after hospice benefit gone, they’ll come after other bits of entitlement programs to pay off debt.
For the NH my mom was in abt 20-25% were on hospice. The extra hands that hospice provided imo helped keep the NH afloat as it allowed for NH staff to spend more time with other residents. NH that are overwhelming Medicaid residents cannot cover operating costs from Medicaid reinbursement alone as avg reimbursement $170 day. They need a mix of private pay, Medicaid and Medicare hospice. If hospice benefit gets gutted, NH will close. Then what?
[ Deana wrote: "Dear Heather,
You have your opinion and I have mine. So let's just leave it at that. Neither of us is going to convince the other that "I am RIGHT and You are WRONG." ☛? ?☚
You take care of your loved ones the way you want to and I will take care of my loved ones the way I want or need to. AND Good Luck to both of us for being caregivers!" }
Excellent advise. I think however, you need to learn to take your own advice.
I am not trying to convince you of anything. This thread is not addressed to you. You are responding to me as if I have addressed you, given personal advice and insist that you follow it.
I have not. I think you need to follow your own instincts. When you do, you need to find a way to be happy with your choices.
My thread is only meant for those who have posted similiar thoughts.
My thread is simply meant for people to read and consider.
There are people on this forum who agree with me, and are open to my information. Please do not post drive by disagreements and then attempt to close the conversation simply because you do not agree.
My first hand experience with my grandfather is my personal experience and I would like to share it for those who are interested and open to it.
Clearly you are not. So what?
If you are confident in your choices. Well, good for you. Stick with that and do not look back. I really do not care what you do or do not do.
Again, if you truly do not agree, and have no personal doubts, then why would my posts affect you. Simply do not read them. I am totally confused. You insist you have no doubts about your choices, but then need to shoot down my opinions.
If you do not agree with my opinion, and my court research, and your mind is closed then the answer is profoundly simply.......take your own excellent advice and stop reading my threads.
It's really not a complicated solution.
I do not believe in luck. My personal opinion is that we have more control than we think. Luck is simply experience meeting opportunity.
I can say with conviction. My grandfather was given weeks to live in a hospice setting.
When I trusted my gut and took him home. He lived another four years.
I am not sure why that offends you so.
You have your opinion and I have mine. So let's just leave it at that. Neither of us is going to convince the other that "I am RIGHT and You are WRONG." ☛? ?☚
You take care of your loved ones the way you want to and I will take care of my loved ones the way I want or need to. AND Good Luck to both of us for being caregivers!
Partial truths, are just that......partial truths.
Simply because some information is missing does not indicate the given information is false.
It may simply indicate that the balance of the information is not yet available.
Also, who determines what is or is not a partial truth?
“It’s relatively rare, but when it happens, it tarnishes the entire field.”
There is enough info. in the article though to get people thinking and checking facilities for mistreatment.
The author of the article, likely watered things down due to editorial policies. As a former journalist, I know that this definitely happens. Articles are tempered for various legal reasons.
In addition perhaps the editorial board realized that most people are often afraid to confront the truth of the horror stories of some of these facilities.
Many people use these facilities unknowingly and innocently because no one raises the awareness of what often goes on in many of them. Yes. Even the good ones.
Most Health care workers are not paid well and these facilities are forced to accept questionable people. Some with criminal backgrounds. Are you aware of that?
It is not easy for a laymen to research criminal records for misdemeanors such as petty theft, minor child or elder abuse, etc.
If you dare to do your homework and read court cases, across the USA, you might be shocked.
I disagree with everything in your prior post, but you are certainly entitled to your opinion, no matter how naive it may be.
Taking care of my grandfather at home for four years with the help of medicare, AND THE PROTECTION OF VIDEO AND AUDIO RELEASES signed by the workers to ensure he was not mistreated, was really not that difficult.
They did most of the work, and I simply dealt with his emotions and reviewed the audio/video tapes regularly.
It is sad, that your feel that at home care is so difficult as to be nigh impossible. That was not my experience. I would not even classify myself as a very strong person, either.
I think your post says more about your own feelings than anyone. Sorry you feel so burdened by caregiving.
My family loved my grandfather. He was a good man. Therefore it was a privilege to take care of my grandfather in my home for four years. My husband and children felt the same way.
Yes. It would have been much easier to put him in a nursing home.
I feel sorry for the people whose caregivers feel burdened by their care.
I think a lot of elderly people would rather be dead than be cared for by someone who sees it as an impossible chore and "no picnic."
My grandfather told me this exactly after my parents left him in a hospice, with only supposedly weeks to live. He said he would rather be dead than cared for by my parents.
He lived a lot longer than a few weeks, with at home care, in my home.
I feel good about that. It was far and away from an impossible task, my dear.
No. It's not pretty, but if handled properly, it certainly is not impossible. I can attest to that.
Sure it's exhausting, but so are a lot of things in life.
Caring for my grandfather for four years at home, did not burn me out. I am sorry you are burned out.
The bottom line is people need to be informed about what is going on so that they can protect themselves appropriately, whether their elder is cared for at home or in a facility.
Either by investigating the facility well, or installing cameras.
There are alternatives. Perhaps not for you, but that is okay. Do whatever you can handle.
However, good luck caring for your dying LO in the home all by yourself during this Very Very difficult and Emotionally Trying time, as Without Hospice help, it would be Near Impossible.
Without Hospice Care, those patients who would Prefer to be allowed to Die at home with their families, would be Forced to go into a Nursing home or other Senior Supportive Living Care, and even there, if Hospice Care is Not being taken advantage of, the services necessary to give the the best possible care during their decent to the end of their lives, like Pain Management, 3XWeekly Nursing Visits, plus 24/7/365 Nursing Care Advice via Telephone, and additional hands on care and other therapies such as Hospice volunteers to sit with the patient, music therapy, physical therapy, scheduled Chaplain visits, 3x weekly bath aides, and hair washes and supplies, and all of the DME equipment, adjustable bed, specialized air mattress and rails, overhead head grab triangle, bedside camode, wheelchair, walker, O2, nasal Canula and tubing, Meds in addition to Pain and Anxiety Medications, IV Therapy and care if required!, hand sanitizer, lotions, peri-anal care supplies, special skin cleaning solutions, wound care meds and ointments and bandages and gloves, chux, adult diapers, Catheter supplies, hand and foot care/nail trims, mouth swabs, thick-it for those with swallowing difficulties, liquid Nutritional Shakes, and Hands On TRAINING and Written Materials, charts for meds, meals, and Physical Health, so you can notice any small changes and what to watch for, and Phone Numbers to Every Available Services you can imagine or Need, to care for your LO, a social Worker assigned to assist the patient for any Social Services necessary through the VA, or other Agency, and Social Worker services for the Caregivers too, helping to find Respite Care, and Counseling for the Burned Out Caregivers, Aditional Nursing Care during patients transitioning into the Active Dying Phase, their presence during your Loved Ones actual dying, and Emotional Support to help you through it and help with Post LO's Death, confirming Time of Death, reporting it to the Health Department, their Hospice Dr, and they also notify the Funeral home to pick up your LO's body for transfer. Plus they offer Grief Counselling for you and all your family members for up to a year or as needed, and so much more.
Without all of these Hospice Care Services, all of this and more would be up to the patient or family to hunt down during this Stressful time, and to supply, searching for all of these resources individually, all the while caring for their critically ill parent, and figuring out whether or not they are covered by their LO's insurance, or figure out how to pay personally for these services as their needs progress.
You can Bash on Hospice Care All you like, you can Always search and find and sight situations where Patients recieved less than stellar care, or find people who "believe" that Hospice mistreated, overmedicated, or even "killed Off" their LO, but if it weren't for the Angels at Hospice, most of our Dying LO's would be Suffering, some in Intractable pain who ultimately end up dying in NH.
If you think a loved one is being mistreated. Withdraw them and report.
Try not to paint them all with the same brush.
As in all things, there are good and there are bad.
If you are going to place something you care for deeply in a facility. It is UP TO YOU to research it first (which I am sure you would/did do)
Does it have a 'waiting list'? If so it is most probably because it is 'well thought' of.
Ask other visitor to it, what they think of it.
Ask patients. Check it 'on line'.
Eat there. Take a tour. Pop in unexpectedly.
Talk to the carers. Talk to the management.
Ask around in the neighbourhood. If you have (or have found any since then) that there are problems, then do not put them there (or take them out of it.)
Try not to panic.
Good Luck
Buzzy
And helpful to readers.
No I do not have a loved one in such a facility, now.
I took my grandfather out four years ago. We cared for him at home with the help of Medicare CNAs.
He died peacefully, but lived far longer than predicted.
The problem is that according to the report, a lot of this negative behavior occurs without witness. And often goes unnoticed.
I think treating it like any business plan is not going to work because caregiving is not like a business plan.
Mainly because, unlike a business where there are a lot of people to notice things, It is not possible for very many people to be around 24/7.
Many people gush about the caregivers and only find out about misbehavior when it is too late.
I think it is easy to put our heads in the sand. Still something needs to be done. If everyone keeps their head in the sand, nothing will change.
Here are a few links:
aarp.org/caregiving/basics/info-2017/elder-abuse-assisted-living.html
"He thought she was just wonderful," Bill Mitchell, deputy district attorney in San Diego, says of Gerald Rabourn's feelings for Goodwin. "He pretty much saw her as his angel."
But after Carolyn died, Goodwin didn't just clean house; she started cleaning up. First, she absconded with nearly $600,000 in assets, including the title to the Rabourn home.
Once the money was gone, Gerald Rabourn disappeared, too, under mysterious circumstances. Arrested in 2011, Goodwin was preparing to leave for a Mediterranean cruise; she was later charged with Gerald Rabourn's murder.
And another depressing link and excerpt:
homehealthcarenews.com/2017/10/hospice-investigation-reveals-rampant-missed-visits-and-neglect/
An excerpt from the link: "In the past five years, families or caregivers have filed more than 3,200 complaints with state officials, leading government inspectors to find problems with 759 hospices. More than half of these were cited for missing visits or other services they had pledged to provide."
More from the link:
While many home health aides are stellar, others, like Goodwin, could be your worst nightmare.
Financial, physical and emotional abuse is on the rise, if the number of arrest warrants and abuse complaints is any indication.
Research suggests that 1 in 10 Americans 60 and over have experienced some form of elder abuse.
More:
But even as prosecutors around the country target elder abuse, many cases go unreported.
And more...
She points to the intersection of a growing elderly population with a burgeoning, virtually unregulated industry of home health care workers as the real culprit.
For starters, there are no federal regulations covering home-care workers, other than broad standards for care provided under Medicaid.
Only about half of all states require home-care agencies to conduct any sort of training for their employees.
The children of 99-year-old Peter Mazza exhausted the inheritance from their father's estate on private home care before turning to the New York Medicaid program.
Family members continued to make daily visits to check on him, and even installed video cameras in his Staten Island home.
They ended up with a horror show: A video from last April shows their father falling and breaking three ribs while reaching for his walker to go to the bathroom as his home aide watches impassively.
They have Nurses, CNA's, Chaplains, Doctors, Social Workers and volunteers.
None of these disciplines are in the house for an extended period of time.
the only ones that would do any "hands on" work would be the CNA, Nurse and Doctor.
If a patient or their family hire a caregiver, privately or through an agency that is between the patient or family and the person they hire
Like any business you plan on using you research.
You interview a Hospice just as you would any Doctor.
Painting ALL Hospice Organizations with the same broad brush is not fair.