How Hospice Became a For-Profit Hustle

[cbabe]

https://www.newyorker.com/magazine/2022/12/05/how-hospice-became-a-for-profit-hustle

How Hospice Became a For-Profit Hustle

It began as a visionary notion—that patients could die with dignity at home. Now it’s a twenty-two-billion-dollar industry plagued by exploitation.

By Ava Kofman
November 28, 2022
(Paywall but one free article)

Over the years, Marsha Farmer had learned what to look for. As she drove the back roads of rural Alabama, she kept an eye out for dilapidated homes and trailers with wheelchair ramps. Some days, she’d ride the one-car ferry across the river to Lower Peach Tree and other secluded hamlets where a few houses lacked running water and bare soil was visible beneath the floorboards. Other times, she’d scan church prayer lists for the names of families with ailing members.

Farmer was selling hospice, which, strictly speaking, is for the dying. To qualify, patients must agree to forgo curative care and be certified by doctors as having less than six months to live. But at AseraCare, a national chain where Farmer worked, she solicited recruits regardless of whether they were near death. She canvassed birthday parties at housing projects and went door to door promoting the program to loggers and textile workers. She sent colleagues to cadge rides on the Meals on Wheels van or to chat up veterans at the American Legion bar. “We’d find run-down places where people were more on the poverty line,” she told me. “You’re looking for uneducated people, if you will, because you’re able to provide something to them and meet a need.”

Farmer, who has doe eyes and a nonchalant smile, often wore scrubs on her sales routes, despite not having a medical background. That way, she said, “I would automatically be seen as a help.” She tried not to mention death in her opening pitch, or even hospice if she could avoid it. Instead, she described an amazing government benefit that offered medications, nursing visits, nutritional supplements, and light housekeeping—all for free. “Why not try us just for a few days?” she’d ask families, glancing down at her watch as she’d been trained to do, to pressure them into a quick decision.

This article is a collaboration between The New Yorker and ProPublica.

Once a prospective patient expressed interest, a nurse would assess whether any of the person’s conditions fit—or could be made to fit—a fatal prognosis. The Black Belt, a swath of the Deep South that includes parts of Alabama, has some of the highest rates of heart disease, diabetes, and emphysema in the country. On paper, Farmer knew, it was possible to finesse chronic symptoms, like shortness of breath, into proof of terminal decline.

…

It might be counterintuitive to run an enterprise that is wholly dependent on clients who aren’t long for this world, but companies in the hospice business can expect some of the biggest returns for the least amount of effort of any sector in American health care. Medicare pays providers a set rate per patient per day, regardless of how much help they deliver. Since most hospice care takes place at home and nurses aren’t required to visit more than twice a month, it’s not difficult to keep overhead low and to outsource the bulk of the labor to unpaid family members—assuming that willing family members are at hand.

…

That summer, Boling pushed Farmer to lobby oncologists to turn over their “last breath” patients: those with only weeks or days to live. At the time, Farmer’s fifty-nine-year-old mother was dying of metastatic colon cancer. Although Farmer knew that the service might do those last-breath people good, it enraged her that her hospice was chasing them cynically, to balance its books. The pressure was so relentless that sometimes she felt like choking someone, but she had two small children and couldn’t quit. Her husband, who had been a co-worker at AseraCare, had already done so. Earlier that year, after fights with Boling and other supervisors about quotas, he had left for a lower-paying job, at Verizon.

Farmer’s confidante at work, Dawn Richardson, shared her frustration. A gifted nurse who was, as Farmer put it, “as country as a turnip,” Richardson hated admitting people who weren’t appropriate or dumping patients who were. She was a single mom, though, and needed a paycheck. One evening in early 2009, the two happened upon another way out.

The local news was reporting that two nurses at SouthernCare, a prominent Alabama-based competitor, had accused the company of stealing taxpayer dollars by enrolling ineligible patients in hospice. SouthernCare, which admitted no wrongdoing, settled with the Justice Department for nearly twenty-five million dollars, and the nurses, as whistle-blowers, had received a share of the sum—$4.9 million, to be exact. Farmer and Richardson had long felt uneasy about what AseraCare asked them to do. Now, they realized, what they were doing might be illegal. They decided to call James Barger, a lawyer who had represented one of the SouthernCare nurses. That March, he helped Farmer and Richardson file a whistle-blower complaint against AseraCare and Golden Living in the Northern District of Alabama, accusing the company of Medicare fraud. The case would go on to become the most consequential lawsuit the hospice industry had ever faced.

…more…

(Quotas, physician bribes, dumping patients, lack of oversight or licensing, false billing, over charging, and more)

[Maraya1969]

1. So maybe that is why my mom died 1.5 years after she was put on Hospice.

I didn't even know someone had to make the decision, (if so it was my brother who had power of attorney)

What really pissed me off is she was in a few different places and also lived with me for a few months during that time but when it came time for her to actually die they didn't move her to one of the Hospice inpatient places until the day that she actually died. I was rushing around trying to get there to be with her and stay overnight if necessary when I got the call that she had passed.


The people that I had known that passed in one of their inpatient places had great care given to them in their last days and they make it very easy for family members to be with them. Now I am wondering whey they waited so long to say she could go in one. It was not easy staying with my mom in her nursing home. There just wasn't a lot of room.


And then I gave them a big donation after her death. Now I find out it is a for-profit company!

[Maraya1969]

2. Wow look at this nice hospice owner who wanted one of his patients overdosed

so he could get out of some Medicare-repayments.


"In Frisco, Texas, according to the F.B.I., a hospice owner tried to evade the Medicare-repayment problem by instructing staff to overdose patients who were staying on the service too long. He texted a nurse about one patient, “He better not make it tomorrow. Or I will blame u.” The owner was sentenced to more than thirteen years in prison for fraud, in a plea deal that made no allegations about patient deaths."