Nursing Homes Forum
This article explores hospice, how it works (and how it doesn’t) in three parts.
PART III - Hospice High Pressure Marketing Practices
As mentioned in the past two articles, hospice is end-of-life care provided to terminal patients. It can be beneficial to patients who receive care in their homes because it provides assistance and education to caregivers. Hospice care provided to a nursing home patient is different - the hospice receives the same amount of money as it does for a home care patient while the nursing home provides all of the care.
Each hospice has its own ethical structure - many agencies are honest and have the patient’s best interests in mind. I’ve encountered many hospices that won’t sign a patient onto their service if they don’t believe that the patient is ready – and they’ll take as much time as necessary to ensure that the patient & family fully understand the program and services. Hospice can be extremely beneficial to help a patient at the end of his life, but it’s not necessarily the best choice for every patient.
The way that hospices are paid makes it easy for them to manipulate the system in their favor. Medicare doesn’t review every chart to ensure the patient needs hospice - and some hospices will do or say just about anything to get patients. The competition is fierce between agencies, and agencies use high pressure sales tactics such as:
- Hiring professional marketers with no medical experience to meet with patients and provide education to the community about the benefits of hospice.
- Leaving out words such as death, dying, terminal and end-of-life when selling hospice to patients.
- Insisting that the patient needs the care immediately, without giving the patients time to consider their options.
- Telling patients the care is “free” without explaining that Medicare is paying the hospice at least $140 every day – not just for the days that the patient is seen by hospice personnel. (Hospice is free to the patient, but costs the Medicare system billions of dollars per year).
- Admitting patients onto hospice before they physically assess the patient; once on service, they’ll be able to bill for at least 90 days ($12,600.00) whether or not the patient needs or qualifies for hospice care.
- Making it difficult for patients to discontinue hospice care or transfer to another agency by sending multiple staff members into the home. This can be intimidating to patients and families.
There are many changes that could be made to ensure that hospices are acting ethically and in the best interests of patients. These changes include:
- Requiring that hospice salespeople hold professional licenses in order to hold these staff members responsible for the information given to patients & families.
- Hospice Medical Directors should not be allowed to refer patients to their own agency (unless there is only one hospice in the area).
- Hospitals should not be allowed to own hospices (in rural areas this may not be feasible).
- There should be a mandatory waiting period to allow patients to learn about available options, and to make a decision as to whether they want hospice and to decide which agency they want. The doctor can prescribe medications to control the patient’s pain & symptoms during this waiting period (and afterward, if the patient chooses not to use hospice services).
- Hospices should be required to provide a price list to the patient showing the actual amounts paid to the hospice each month.
- Medicare should change the criteria required for people who are elderly, as currently just about anyone can qualify for hospice.
- Medicare should reduce the payment for long-term patients in nursing homes by at least half, as these patients receive less care from the hospice.
- Hospices should provide patients with a form that informs the patient how to stop service, and how to transfer to another hospice at any time.
- Hospices should have to sign a patient off of service if the patient doesn’t meet the medical criteria, rather than continuing to bill for the remainder of the 90-day certification period. Hospices should not be paid for the time that patients are still on service but don’t need it.
- Physicians should have to submit documentation that clearly justifies why the patient needs hospice care, rather than the signature that is currently required.
- Patients/families should be provided with a number to Medicare they can use for complaints, and there should be adequate staffing to follow up on the complaints.
Hospice care was created to provide options for patients, and can be a wonderful gift for people who need end-of-life care. But the program has morphed into a huge money-maker for hospice-certified agencies while oversight has decreased dramatically as states attempt to balance their budgets. Tightening the rules won’t affect those agencies who act in an ethical manner, and patients who benefit from end-of-life care will continue to receive hospice.
Sharon Johnson, BSW, is a Social Worker with over 18 years of direct experience working with the elderly. She is the author of several books on senior care issues and Executive Director of Case Management Solutions, LLC. Her books can be purchased at at www.cmseldercare.com
5 comments on “Hospice Programs Explained: High Pressure Marketing Practices”
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Joined: 23 Apr 2010
Posts: 0
Comments: 1
I am here at 3 am because I can’t sleep. A local hospice is caring for my father. The problem lies in the fact that they are convincing my mother that SHE needs hospice, too! Her doctor would not sign the papers as he does not agree that she needs hospice. They promised to take my mother papers to sign to end the service.
Then yesterday, I popped in with dinner, and there were two people putting pressure on my mother to stay on the service. (This is two weeks after she asked to be removed). Now she says she just wants to die. She is a vital 80 year old with some heart failure, but otherwise healthy and her mind is great.
What can I do to stop them from harrassing my mother, just when she’s feeling better about life?!! This is truly scary. They are manipulating her and agreeing that she “shouldn’t live to be a burden to her children”. Please help.
Thank you you for listening and any advice you can give.
Joined: 30 Jun 2009
Posts: 16
Comments: 132
Do you have a 1) local government division of Senior Services run by your county or 2) APS division (Adult Protective Services)? If there is elderly harassment going on they may be able to help. It may be worth a call to them and ask what your options are.
When calling tell them there is harassment/abuse you have witnessed and you need to speak to someone. Keep calling back if you do not get through to a case worker within 24-48 hours - they are very short staffed now do to deep budget cuts. Be sure to mention her own doctor refuses to comply with what the staff is repeatedly recommending and pushing on her.
If nothing else, perhaps they could send a social worker to speak with her to authoritatively regarding life choices other than what is presented by the staff at that hospice.
Your poor Mom! Good luck.
Joined: 23 Apr 2010
Posts: 0
Comments: 2
Call a local TV news station. Ask to speak with their Investigative reporter. Tell them your story. They LOVE this kind of story. Expose them. Also hire a medical lawyer and have them send them a very strong letter that you will sue them.
Hit em’ from all sides. To me it sounds like she’s being held prisoner and brain washed all for the almighty dollar.
If all else fails.. take your mom “out to dinner” some night and just don’t return her to the hospice. Save her life! I’m really not kidding here.
I do wish you and your mom well.
Joined: 12 Aug 2009
Posts: 0
Comments: 1
Could someone please provide links to Part 1 and Part 2 of this article? Thanks.
Joined: 24 Aug 2007
Posts: 161
Comments: 2818
elliemae's website
Here are parts one & two:
http://patrick.net/forum/?p=16353
http://patrick.net/forum/?p=16361
I’ll have them posted on my own website, hopefully this weekend. However, I’m having a bit of an argument with my computer & the interweb, and am borrowing the neighbor’s.
grandeefloats says
It would be helpful if you would tell me what state you live in - there is a power of attorney for healthcare form accepted in each state that you could have both your mother & father complete. Do that - of if you already have poa, call different hospices in your town and find one that will transfer your father onto their service. They will help you do so - but it would be helpful to call the doctor and tell him that you’re doing this.
Call the hospice after you’ve made arrangements to transfer your father to an ethical hospice program, and demand that they come over immediately with Revocation Paperwork. If they don’t show up within an hour, there should be a phone number for complaints on the paperwork your parents signed to get them on service.
Once again, if you tell me that state and city, I can give you other options and the phone number of the agency to which you can complain.
Change the locks on your parent’s house if the hospice has a key. If it’s one of those “left under the mat” situations, they probably made a copy.
You have the rights here, and you should exercise them. Have you spoken with the director of the hospice and told them that your next call is to the TV news, your attorney, and the state regulatory agency? Place their equipment outside the door and don’t let them back in - but if your father needs hospice, by all means find another and have them help you.
I worked for a national hospice that used tactics such as this - they don’t enjoy the negative publicity and neither do they enjoy the prospect of the state coming and reviewing their charts. And when it’s over, file a complaint anyway. Keep the information they’ve left there - and openly record every conversation.
Please let me know if I can give you more information - I’m very sorry for what you’re going through. It sounds like they signed your mother onto service using their medical director and they’re not gonna let them go without a fight. Of course, every day they delay the discharge they’re receiving $300 for both of them.
-elliemae (Sharon)