Title: More Attention Needed to Prevent Abuse and Neglect in Hospice Care Description: When Medicaid and Medicare programs pay for nursing home or hospice care, the government requires participating hospitals, nursing homes and hospice providers to protect individuals from abuse or neglect. But federal requirements may differ, leaving gaps in protection. We find out more from GAOƒ's John Dicken. Related GAO Work: GAO-23-105463, Abuse and Neglect: CMS Should Strengthen Reporting Requirements to Better Protect Individuals Receiving Hospice Care Released: January 2023 [Music] [John Dicken:] Vulnerable individuals who rely on extended skilled care from nursing homes or hospitals have the right to be free from abuse and neglect. [Holly Hobbs:] Hi and welcome to GAO's Watchdog Report, your source for news and information from the U.S. Government Accountability Office. I'm your host, Holly Hobbs. When families decide to put their loved ones in nursing homes or end of life care, like hospice care, they want assurances that their loved ones are being taken care of. When Medicaid and Medicare programs pay for this care, the government has requirements for protecting individuals from abuse and neglect. But these patients are particularly vulnerable, and federal requirements may leave gaps in protection. Today, we'll talk with John Dicken, an expert on health care policy, about our review of requirements and some of the concerns we found. Thanks for joining us, John. [John Dicken:] Thank you. [Holly Hobbs:] So, John, what led us to look at this issue? Were there reports of abuse and neglect or some concerns? [John Dicken:] Yes. GAO and others, such as the HHS Office of Inspector General, have reported on the abuse of residents in nursing homes and individuals in other extended care settings. For example, we found that while relatively rare, instance of physical, sexual and emotional abuse of nursing home residents were increasing in recent years, and we have made some recommendations for improving federal oversight. [Holly Hobbs:] And so the Centers for Medicare & Medicaid Services (CMS) are responsible for monitoring abuse and neglectƒ-including through reporting requirements. But we found some gaps in these requirements, right? [John Dicken:] Yes. In particular, we found two gaps in reporting requirements for hospice providers that differ from the requirements that exist for nursing homes and extend care hospitals. And these gaps can result in less complete and less timely reporting of potential abuse or neglect for hospice providers. The first gap is that CMS does not require hospices to report abuse, neglect allegations to state agencies or to the hospice administrator when the alleged perpetrator of the abuse is not affiliated with the hospice directly. And so if the abuse were done by a family member or someone that was not affiliated with the hospice, another type of caregiver, that is not necessarily required to be reported by the hospice. That's different from nursing homes or hospitals. The second gap that we found was that even when the alleged perpetrator is affiliated with the hospice, hospices are not required to report allegations of abuse and neglect externally until after the hospice itself has conducted its own internal investigation. And then only a subset of those allegations, those that were verified by the investigation, are required to be reported. [Holly Hobbs:] So does this make hospice patients more vulnerable than, say, nursing home care or hospital patients? [John Dicken:] Well, certainly individuals near the end of life receiving hospice care are potentially vulnerable to abuse or neglect. But there are some unique aspects of hospice care that can further heighten the vulnerability in these situations. One important factor is that hospice care is often provided in different settingsƒ₪”most often in an individual's personal home. The research shows that most abuse of older individuals is committed in the home by individualƒ's caregivers. So that's why it's particularly concerning that those incidents are not required to be reported to the hospice or to the state. It may also mean that there are fewer opportunities for abuse or neglect situations to be identified when care is in a personal home compared to a nursing home or a hospital where a resident interacts with a broad range of staff and visitors, who can also identify or monitor the resident's well-being. [Holly Hobbs:] If there are families listening to this, they're going to want to know how they can find out if a nursing home or hospice provider has allegations of abuse or neglect. What can we tell them? [John Dicken:] Yeah. One source is through the website Medicare.gov. And on Medicare.gov there's a feature called Care Compare that provides information for different types of Medicare providers, including both nursing homes and hospice providers. And this does include information on the state's inspections and any deficiencies, including those related to abuse. There's also a red flag for a nursing home on Care Compare that's literally a hand in a red circle for nursing homes that have been recently cited for resident harm or potential abuse or neglect. So that's a nationally available initial source of information. Certainly each state's health department or licensing agency for hospital providers and nursing homes can also provide information, and others in the community that may be familiar with a nursing home or hospice provider. {MUSIC} [Holly Hobbs:] So John just told us that even though the Centers for Medicare & Medicaid Services have requirements for preventing abuse and neglect, there are differences for care provided in-home, which may leave patients in hospice care more vulnerable. John, given some of the differences we found in requirements, what do you think needs to be done to better protect those in hospice care from abuse and neglect? [John Dicken:] GAOƒ's recommending that CMS would require hospice care providers to report all allegations of abuse and neglect immediately to state agencies, and that that information would be available then also for the federal Medicare and Medicaid agency, CMS. And that would be regardless of whether the alleged perpetrator is affiliated with the hospice or otherwise. That would really allow more assurance that hospices are taking steps within their authority to identify and report these situations and make corrections as appropriate, and that the federal government can hold responsible hospices that they are meeting those obligations. [Holly Hobbs:] And last question, what's the bottom line of this report? [John Dicken:] Certainly vulnerable individuals, who are near the end of life or who rely on extended skilled care from nursing homes or hospitals, have the right to be free from abuse and neglect. But we found some gaps, especially in hospice reporting requirements. We think that strengthening these hospice reporting requirements will provide the information necessary that can help ensure that hospice care providers are taking appropriate steps to protect vulnerable individuals. [Holly Hobbs:] That was John Dicken talking about GAO's recent review of CMSƒ's abuse and neglect reporting requirements. Thanks for your time, John. [John Dicken:] Thank you. [Holly Hobbs:] And thank you for listening to the Watchdog Report. To hear more podcasts, subscribe to us on Apple Podcasts, Spotify, or wherever you listen and make sure to leave a rating and review to let others know about the work we're doing. For more from the congressional watchdog, the U.S. Government Accountability Office, visit us at GAO.gov.