1 00:00:02,000 --> 00:00:04,800 JUDY WOODRUFF: Now: There are 4,000 hospice agencies around the country. 2 00:00:04,800 --> 00:00:09,800 And a new report has some disturbing findings showing neglect for too many patients and 3 00:00:10,400 --> 00:00:11,366 their families. 4 00:00:11,366 --> 00:00:13,933 John Yang has the story. 5 00:00:13,933 --> 00:00:17,866 JOHN YANG: In-home hospice care promises 24/7 support for a dying patient's physical, emotional 6 00:00:19,800 --> 00:00:24,033 and spiritual needs, allowing them to spend their final days at home. 7 00:00:24,033 --> 00:00:29,033 But a new investigation has found that calls for help in times of crisis have sometimes 8 00:00:30,400 --> 00:00:33,833 been met by delays, no-shows and unanswered calls. 9 00:00:33,833 --> 00:00:38,533 Here to talk about this is one of the reporters who conducted the investigation, JoNel Aleccia, 10 00:00:38,533 --> 00:00:43,533 a reporter for Kaiser Health News, which is an independent service not associated with 11 00:00:44,300 --> 00:00:45,533 Kaiser Permanente. 12 00:00:45,533 --> 00:00:47,266 JoNel, thanks so much for joining us. 13 00:00:47,266 --> 00:00:51,500 You worked on this with your colleague Melissa Bailey. 14 00:00:51,500 --> 00:00:54,366 Tell us what you found, sort of the magnitude of what you found. 15 00:00:54,366 --> 00:00:56,700 JONEL ALECCIA, Kaiser Health News: Yes, we did. 16 00:00:56,700 --> 00:01:01,700 You know, we took a look at about 20,000 hospice inspection record from Medicare, and those 17 00:01:05,100 --> 00:01:08,333 included about 3,200 complaints. 18 00:01:08,333 --> 00:01:13,333 And of those, more than 700 were confirmed and found to have problems. 19 00:01:15,366 --> 00:01:19,066 We looked at those, and more than half of the inspection reports and the complaints 20 00:01:19,066 --> 00:01:23,200 with problems were from people who had missed visits, 21 00:01:23,200 --> 00:01:27,166 no-shows and other kinds of services that they were promised that were missed. 22 00:01:27,166 --> 00:01:31,900 JOHN YANG: And an example of this, we have got -- you folks at Kaiser Health News produced 23 00:01:31,900 --> 00:01:34,500 a video part of this report. 24 00:01:34,500 --> 00:01:39,500 This is Patricia Martin of Wasilla, Alaska, talking about her struggle to get pain medication 25 00:01:40,733 --> 00:01:42,900 for her husband as he died of cancer. 26 00:01:42,900 --> 00:01:45,433 PATRICIA MARTIN, Alaska: So, I called them. 27 00:01:45,433 --> 00:01:50,000 And I said, we didn't get the pain medication. 28 00:01:50,000 --> 00:01:55,000 And they said, oh, well, we can't get ahold of the doctor, because he is sleeping because 29 00:01:56,466 --> 00:02:01,466 he works at night at the hospital on Saturday. 30 00:02:03,433 --> 00:02:07,800 He said to me, "I thought I was going to get pain relief" when we got into hospice. 31 00:02:11,433 --> 00:02:16,000 JOHN YANG: The Alaska Department of Health and Social Services concluded in that case 32 00:02:16,000 --> 00:02:21,000 that the hospice failed to properly coordinate services for the Martins. 33 00:02:22,200 --> 00:02:24,233 How typical was that -- is this example? 34 00:02:24,233 --> 00:02:29,000 JONEL ALECCIA: You know, Pat Martin's situation was, sadly, really typical of the situations 35 00:02:32,333 --> 00:02:35,366 that we found in those complaint records. 36 00:02:35,366 --> 00:02:39,833 We combed through them and were able to track down people through death records and other 37 00:02:39,833 --> 00:02:41,866 public records. 38 00:02:41,866 --> 00:02:44,900 But Pat's case was, sadly, very common. 39 00:02:44,900 --> 00:02:49,733 We had other people where they delivered boxes of medication without telling them how to 40 00:02:49,733 --> 00:02:51,533 use it. 41 00:02:51,533 --> 00:02:55,300 They had nurses that they would call in the middle of the night. 42 00:02:55,300 --> 00:03:00,133 One nurse that we reported about, her cell phone was on silent, and she missed 16 calls 43 00:03:00,133 --> 00:03:04,033 for help as this woman's husband was dying. 44 00:03:04,033 --> 00:03:07,633 JOHN YANG: What was the industry response to what you found? 45 00:03:07,633 --> 00:03:12,633 JONEL ALECCIA: You know, what the industry said is, no situation like that is tolerable 46 00:03:15,100 --> 00:03:17,166 or appropriate. 47 00:03:17,166 --> 00:03:21,100 But they emphasize that most people who enroll in hospice are happy with the experience. 48 00:03:23,566 --> 00:03:28,566 And they said that these cases are a small minority of the typical cases that you will 49 00:03:30,066 --> 00:03:32,133 find in hospice. 50 00:03:32,133 --> 00:03:35,366 JOHN YANG: In your report, you pointed out that a lot of this was paid for by Medicare 51 00:03:35,366 --> 00:03:40,366 and that hospice gets -- the hospice services are paid for by about $16 billion a year in 52 00:03:43,933 --> 00:03:45,166 Medicare funds. 53 00:03:45,166 --> 00:03:47,133 These are taxpayer funds. 54 00:03:47,133 --> 00:03:50,833 What sort of oversight does Medicare have over these services? 55 00:03:50,833 --> 00:03:55,833 JONEL ALECCIA: Well, Medicare -- you know, Medicare is responsible for oversight of the 56 00:03:56,466 --> 00:03:58,533 hospices. 57 00:03:58,533 --> 00:04:02,000 But, you know, what is not often known is that these hospices aren't inspected as frequently 58 00:04:03,166 --> 00:04:06,166 as nursing homes are, for instance. 59 00:04:06,166 --> 00:04:09,633 They don't have to be inspected every year. 60 00:04:09,633 --> 00:04:14,566 You know, they just changed the rules, and starting in 2018, they will have to be inspected 61 00:04:14,566 --> 00:04:16,500 every three years. 62 00:04:16,500 --> 00:04:20,966 So, Medicare is responsible for oversight of these hospices, but it doesn't appear to 63 00:04:21,633 --> 00:04:23,133 be enough. 64 00:04:23,133 --> 00:04:25,833 JOHN YANG: In -- we have got less than a minute to go. 65 00:04:25,833 --> 00:04:29,000 What can families do to try to avoid these problems? 66 00:04:29,000 --> 00:04:34,000 JONEL ALECCIA: Families can ask questions about how people respond to patients in emergencies. 67 00:04:36,600 --> 00:04:41,600 If they have time, they can ask their local state -- the state health department for the 68 00:04:44,000 --> 00:04:47,466 inspection records at the hospice that they plan to use. 69 00:04:47,466 --> 00:04:52,466 But, mostly, they need to ask questions about what happens late in the night and when patients 70 00:04:54,433 --> 00:04:56,866 are at their worst. 71 00:04:56,866 --> 00:05:01,000 JOHN YANG: JoNel Aleccia Kaiser Health News, thank you so much for telling us about this 72 00:05:01,000 --> 00:05:02,666 really startling report. 73 00:05:02,666 --> 00:05:05,133 JONEL ALECCIA: Thanks for having me. 74 00:05:05,133 --> 00:05:09,266 JOHN YANG: And you can read the full Kaiser Health News report on our Web site, PBS.org/NewsHour.