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Additional reporting makes sense for hospitals and SNFs, not hospices, HHS maintains.

Hospices aren鈥檛 doing as good a job reporting abuse and neglect of their patients as hospitals and skilled nursing facilities are, says a watchdog agency that wants to change that.

Hospices have received a boatload of scrutiny over quality of care in the wake of two HHS Office of Inspector General reports regarding hospice survey findings, issued in 2019. The reports included horror stories, including hospice patients with maggots and gangrene leading to amputations (see HHHW, Vol. XXVIII, No. 24).

In November 2020, Senate Finance Committee Chair Charles Grassley (R-Ia.) requested the Government Account颅ability Office 鈥渆xamine the definitions and requirements related to abuse and neglect among selected Medicare- and Medicaid-certified health care settings,鈥� including hospices, the GAO says in its new report on the topic released Jan. 11.

Findings: 鈥淕AO鈥檚 review of Centers for Medicare & Medicaid Services (CMS) requirements for reporting and responding to abuse and neglect allegations found two gaps in the requirements for hospices, compared with requirements for extended care provided in hospitals and nursing homes,鈥� the GAO says in its report summary. 鈥淗ospices 鈥� are required to report allegations to the state agencies responsible for monitoring them only if: (1) the alleged perpetrator is affiliated with the hospice; and (2) after the hospice has verified it as abuse or neglect based on an internal investigation that could take up to 5 days. In contrast, nursing homes and hospitals 鈥� are required to report all abuse and neglect allegations, regardless of whether the alleged perpetrator is affiliated with the hospice and prior to conducting an internal investigation.鈥�

Hospices aren鈥檛 compelled to report non-hospice abuse and neglect 鈥渆ven though research suggests that most abuse of older individuals is committed in the home by an individual鈥檚 caregivers, such as family members,鈥� the GAO highlights. That means 鈥渉ospice care providers鈥� reporting may be less complete or timely than that of nursing homes and hospitals providing extended care,鈥� the agency concludes.

Recommendation: 鈥淕AO recommends that CMS require hospice care providers to report all allegations of abuse and neglect immediately to survey agencies, regardless of whether the alleged perpetrator is affiliated with the hospice,鈥� the report says.

CMS regulations already require reporting of abuse and neglect, but sometimes that reporting is to local or state authorities, Health and Human Services official Melanie Ann Egorine says in HHS鈥� response to the report.

鈥淚n addition 鈥� CMS requires hospices to comply with all federal, state and local laws related to the health and safety of the patient,鈥� Egorine says in the response letter. 鈥淭his would include state mandatory reporting requirements relating to suspicions of abuse and neglect by any person, whether or not they are acting on behalf of the hospice.鈥�

In other words, CMS doesn鈥檛 need to implement any new reporting requirements, Egorine implies. However, 鈥淐MS will review its interpretive guidance for opportunities to clarify existing guidance on reporting these allegations to appropriate authorities,鈥� Egorine pledges. Reporting directly to state and local authorities 鈥渕inimiz(es) bureaucratic layers of responsi颅bility that could create confusion in reporting processes and requirements,鈥� she continues. 鈥淭here is no indication that adding an additional requirement would strengthen existing state and local requirements.鈥�

Additional reporting requirements for nursing homes and hospitals 鈥渞eflect the nature of the environment in which the patient is located,鈥� Egorine adds. 鈥淭hese are settings where the provision of care and services are under the control of the provider on a continuous basis,鈥� she concludes.

Note: Links to the 30-page report and a related GAO podcast are at .