In the wake of terrible conditions of negligence and abuse reported at some U.S. hospice facilities, several Catholic doctors are emphasizing the need for Christians to embrace a ministry of aiding hospice patients and their families. “How can anyone be other than shocked and saddened by the cases reported?” Dr. Barbara Golder, M.D., J.D. told CNA July 10. “It breaks my heart, and I suspect anyone who has a loved one in hospice or extended residential or skilled nursing care worries about these things. This report makes it clear such worries are not unreasonable.” The Office of Inspector General for the Department of Health and Human Services on July 9 released two reports on U.S. hospice care, CNN reports. These reports said that more than 80% of end-of-life facilities had at least one deficiency.
Over 300 facilities, about 18%, had serious problems that jeopardized patients’ health and safety, the reports said. Golder, the editor-in-chief of the Catholic Medical Association’s official journal, the Linacre Quarterly, told CNA that such reports are designed to highlight problems which must be fixed immediately. “It’s also important to remember that there are excellent hospices that provide splendid care for their patients,” she said.
The worst cases of negligence and abuse in the new reports included a dying man whose feeding tubes had maggots growing around it, and a case in which caregivers failed to treat a patient with Alzheimer’s disease to such an extent that his leg had to be amputated. In yet another case, those responsible for a hospice patient failed to recognize signs on her body of sexual assault. One woman in hospice care was repeatedly abused by her daughter, who was also her caregiver. The hospice’s social worker was notified of the signs of abuse, but he did not visit for several weeks and then did not assess the patient’s safety.
Another patient’s neighbor repeatedly entered his apartment “naked, high and drunk” and stole medications including opioids and anti-anxiety pills. Several hospice employees were aware of the situation but the hospice planned no further action to notify law enforcement or to ensure patient safety. Hospice care in the U.S. received $17 billion in Medicare funds in 2017, serving over 1.5 million patients.
End-of-life care in the U.S. is increasingly discussed in the context of debates over legal assisted suicide, and Golder suggested reports about poor hospice care show the need to address the fundamental fears and concerns of people vulnerable to suicide. “People who opt for assisted suicide often do so because they fear losing their dignity and value as people, rather than because they are in intractable pain or near the end of life,” she told CNA. “Reports of care like this – which clearly fails to respect the person – only feed that fear. It isn’t hard to imagine a patient deciding to end his life rather than risk hospice care if he fears that he will be treated as patients were in the most egregious cases outlined in the report.”
Golder encouraged parishes to take account of local people who are in hospice care and ask whether there is a way for the community to be aware of problems and to respond as communities and as individuals. “Who are the patients in local facilities who have no one to visit and are thus more likely to be abused?” she asked. “Are we stepping up? Are we encouraging each other to do so?” “Part of our call as Christians is to be present in the lives of the suffering long before it comes down to that choice, and both share in that suffering, and accompany the suffering patient so that the fear of worthlessness – as well as the risk of bad care – can be alleviated.”
The Christian faith in Jesus Christ can also be an explicit part of end-of-life care, Deacon Alan Rastrelli, M.D., told CNA. The Archdiocese of Denver deacon is a member of both the American Academy of Hospice and Palliative Medicine and the Catholic Medical Association. “It is never too late, and that is where I concentrate my efforts to help those in doubt and despair know that Jesus, the Divine Physician, is always there with His hand reaching out,” Rastrelli said. “With this kind of care, that is the antidote to defuse the cry for assisted suicide and euthanasia – so patients and families can be assured of dignified care during the rest of their natural life, and avoiding aborting life at the end.”
Rastrelli told CNA he moved from anesthesiology into hospice and palliative medicine in order to address deficiencies in normal medical care at the end of life.
“End-of-life care requires addressing not just the somatic or physical symptoms, such as pain, but also the emotional, psychological, financial, and importantly spiritual component to a patient’s suffering,” he said.
By Kevin Jones
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