Like most readers, and as someone who understands and appreciates the importance of hospice care, I was upset by the report from the Office of the Inspector General that highlighted disturbing occurrences of substandard care at a Missouri hospice. The report also received, and merited, a response from the editorial board of the Post-Dispatch.
As chief executive of the Missouri Hospice & Palliative Care Association, and on behalf of the members we represent, I wholeheartedly condemn the instances of neglect and abuse outlined in this report. The deficiency cited happened in 2016 and was investigated by Missouri’s Department of Health and Senior Services. The hospice in question was required to complete a plan of correction and has been inspected by surveyors many times since then.
Our state surveyors in Missouri do an excellent job with inspections and complaint surveys. Changes in federal law since 2015 have increased the number of inspections, and these changes have helped make sure that our hospices are providing the best care to patients.
It is important, however, to recognize that the inspector general’s report also acknowledged the case studies selected for the report are not representative of the majority of hospices. The report also notes that a majority of the identified deficiencies were minor infractions, which include paperwork or reporting errors completely unrelated to direct patient care.
Still, we know that any instance of neglect is one too many. Missouri hospices cared for 41,234 individuals in 2018, and everyone in our state who needs hospice deserves access to care that meets the highest standards.
For this reason, the leaders in the hospice community are working with policymakers to improve the provision of high-quality, person-centered hospice care by promoting reforms that increase access, improve transparency, advance education and training, and expand oversight of poor-performing hospices.
First, greater transparency on hospice-program performance would help ensure that patients and families can access reliable data when making care decisions. As noted by the Post-Dispatch, “hospice care is one of those services often ignored by the general public because it is only needed when a loved one is diagnosed with a terminal illness.” Patients and families should be confident that a Medicare-certified hospice will provide high-quality care, and people should be able to access reliable data that supports the choices they make.
Making reliable data available to consumers is a step in the right direction to ensure those in need are matched with a program that works for them. Missouri’s Department of Health and Senior Services offers consumers the opportunity to view any substantiated complaints concerning all hospices in Missouri. We encourage consumers to review the page as part of their toolkit when looking for a hospice. In addition, Missouri Hospice & Palliative Care Association has considerable hospice consumer information on our website.
Second, hospice programs must prioritize professional education and training for staff and volunteers as an ongoing commitment that must be part of an organization’s culture. High-quality care, regulatory compliance, and clinical excellence require ongoing education. We owe this to our teams as well as the people they serve. I can’t stress enough the importance of taking advantage of continuing education for every discipline that works in hospice.
Last, poor-performing hospice programs deserve and need increased oversight. A well-defined, targeted oversight program would allow for smarter oversight that more closely monitors program performance and helps to shut down hospices that fail to improve.
No one understands better than hospice and palliative care providers that we have one chance to get it right with patients and families — and most do. While it doesn’t make headlines, what truly represents our profession is a chaplain who prays with a patient, a nurse who provides pain relief, or a family who finds comfort thanks to bereavement support. These stories are real and happen every day. I have listened to many stories of incredible hospice care and service by our hospice staff. Let’s not forgot the greater positive impact hospice care has in our state for our families and our patients.
Jane Moore is the chief executive for the Missouri Hospice & Palliative Care Association based in Jefferson City.