ANNAPOLIS State inspectors visiting hospice programs have uncovered long-standing and serious problems that the current 10-year inspection cycle allows to continue for too long, the licensing director of the state health department told the General Assembly this week.
One program that was last inspected six years before had several long-running problems uncovered in a recent inspection. The program made no assessments of patients and created no care plan for them, said Carol Benner, with the Department of Health and Mental Hygiene.
Caretakers of the hospice, which she declined to name, also were not following dietary restrictions for patients. One patient was fed chicken soup with chunks of chicken when his diet called for only pureed food. When the inspectors pointed this out, they were told, “Well, that patient is dying anyway,” Benner said.
Other patients were fed white gravy from gravy boats, Benner said.
“The people who were running this hospice didn’t understand that there were standards to live up to,” Benner said.
Hospice care services are designed to provide compassionate support for people in the final phase of a terminal illness, helping patients manage symptoms and eliminating pain throughout their last days. Once a patient enters hospice care, their life expectancy is six months or less, according to the National Hospice Organization.
A bill has been introduced in the Maryland House of Delegates that would require yearly inspections of Maryland’s 38 hospice facilities. A federal law requires an inspection every 10 years, but Benner doesn’t think that’s enough.
“It’s a very reasonable bill and I don’t think it’s going to have any problems passing,” said Delegate Donald B. Elliot, R-Carroll.
The proposed bill which is sponsored by the chairman of the Environmental Matters Committee, Ronald Guns, D-Cecil, had its first hearing on Wednesday.
Although they’re supportive of the bill, Benner and representatives from hospice organizations said they were concerned about its wording. The bill now requires an annual inspection of “hospice facilities.” Benner said she is afraid the word facility will be misinterpreted as buildings alone and wants it changed to “hospice programs.”
Most hospice programs do not have in-patient facilities, although they have headquarters buildings, Benner said. They work with patients in their homes. She wants to make sure the bill would allow inspectors to go into those homes to observe the caregivers. Federal law permits such inspections, but only every 10 years.
Concerned about invasion of privacy, Delegate Nathaniel T. Oaks, D-Baltimore, asked how they determine which homes they visit.
Before going to a home, Benner responded, the department gets permission from the patient and the patient’s family. In the past, families have asked that inspectors not come into their homes, and the department always respects their wishes, she said.
“Each program has approximately 100 patients and out of that number we usually have no trouble finding one or two patients who don’t mind having the inspectors there,” Benner said. “The patients understand this is to their benefit.”
Another major concern about this proposal is cost. The Department of Health and Mental Hygiene is requesting an additional $116,100 for fiscal year 2000, to improve the hospice inspection program. The department now pulls inspectors from other departments, and the money would establish a separate division. The estimated cost includes the salaries and benefits for two survey nurses and one administrative specialist.
Even now the inspection program is not self-supporting. Each hospice program pays a license fee of $100 a year, giving the department only $3,800 in fee revenues. Other funding comes from the state and federal governments.
Elliot said he was worried about the cost to hospices.
“I don’t question the need for the money, but I don’t want this to be a sort of foot in the door to get this authority, and then see legislation next session to boost up the license fee to cover this cost,” Elliot said.
That is the concern many of the hospices have, as well.
“We serve the public so we always welcome having inspections to prove that we are a quality program. If money is being spent and these inspections are already being done. We don’t want to spend extra money,” said Katherine Boyne, acting president of Hospice of Baltimore.
There is money in the budget to cover this, Benner said. There are no plans to increase the license fee.