Hospice care has a big problem

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Jul 05, 2023 View in browser   By Joanne Kenen A terminally ill hospice resident sits with a music therapist in her bed in Lakewood, Colorado. | John Moore/Getty Images A LITANY OF WRONGS — A number of years ago, when I had a fellowship to write about end of life care across the United States, a geriatrician in California told me, “There are no do-overs in death.” A group of prominent physicians who specialize in end of life care think it may be a do-over time for hospice. Or at the very least a gut-check. Once a movement, hospice is now an industry dominated by publicly-traded companies and private equity firms, and it’s been the subject of critical government reports and withering exposes, including a New Yorker-ProPublica investigation of the “for profit hustle.” Today, with half of all Americans dying in hospice care, some doctors believe its challenges are in urgent need of fixing. In a six-page “call to action” recently published in the Journal of Palliative Medicine, 325 prominent doctors in this field wrote that “in recent years, we have observed an increasing prevalence of serious deficiencies in hospice care and high variability in quality of care.” Instances of “poor care,” they said, are “increasingly common.” The signatories (some of whom are retired) include pioneers in the field, including two-thirds of the living former presidents of the American Academy of Hospice and Palliative Medicine, the professional society for these physicians. Ira Byock, a long-time hospice and palliative medicine physician who was the lead author, told Nightly that the Academy and the main hospice trade group should do more to set quality standards and promote transparency. That would help government regulators focus on what matters to patients and families, rather than generating a lot more administrative hassles. The essay in the journal cited a litany of wrongs — not enough physician involvement in patient care, unmanageably large nurse caseloads and inadequate, interdisciplinary care teams. The nurses, doctors, social workers, chaplains and others who are the core of hospice care, which generally takes place in patients’ homes, are overworked or not properly trained. They also said some hospices don’t have the required backups for emergencies, such as intense pain or difficulty breathing that families can’t take care of themselves. That means families dial 911, and patients end up back in the very hospitals that they chose hospice to avoid. Some issues the essay cites reflect challenges in U.S. health care across the board — like nursing shortages after the pandemic. Others reflect the changing nature of hospice ownership and the Medicare payment system. The authors want the statement to be a roadmap as physicians negotiate with employers so they can provide consistently good care. Ben Marcantonio, interim CEO of the National Hospice and Palliative Care Organization, the trade group, told Nightly that a small number of hospices that have committed “actually fraudulent behavior” have tarnished how hospice overall is perceived. The industry, he said, has also called for federal resources to educate health providers in the field, which will help with both workforce shortages and quality. And they’re working with the Center for Medicare Services on quality measures “that really do put the focus in the right place.” They also want Medicare to pay hospices more. Dr. Holly Yang, president of the American Academy of Hospice and Palliative Care and a practicing palliative care physician in San Diego, said she doesn’t think hospice’s challenges revolve so much around nonprofit vs for-profit ownership, but about the Medicare hospice benefit itself. A lot has changed since Congress added hospice to Medicare in 1982 — how we age and die, and where and how families live and work and who is available to stay home and care for a dying relative. The hospice benefit “has not changed with the times,” said Yang, who also trains upcoming hospice and palliative care doctors. Hospice in its early days was very focused on cancer, which had a more predictable and shorter course than it does with today’s treatments. And more people in hospice have conditions like dementia or congestive heart failure, where the trajectory is uncertain. People can live with serious illness for a long time but need support. For Byock and his colleagues, calls for legislative change aren’t enough, particularly as advocates have been calling for remedies for several years and Congress isn’t racing to comply. Hospice, they say, needs to do more to protect quality, to protect “vulnerable seriously ill people with their families” on its own. There may be no do-overs in death. But maybe it’s time for a do-over of hospice. Welcome to POLITICO Nightly. Reach out with news, tips and ideas at nightly@politico.com. Or contact tonight’s author on Twitter at @JoanneKenen.   JOIN 7/11 FOR A TALK ON THE FAA’S FUTURE: Congress is making moves to pass the FAA Reauthorization Act, laying the groundwork for the FAA’s long-term agenda to modernize the aviation sector to meet the challenges of today and innovate for tomorrow. Join POLITICO on July 11 to discuss what will make it into the final reauthorization bill and examine how reauthorization will reshape FAA’s priorities and authorities. REGISTER HERE.     What'd I Miss? — White House cocaine culprit unlikely to be found, says law enforcement official: Law enforcement officials confirmed today that cocaine was found at the White House over the weekend. But one official familiar with the investigation cautioned that the source of the drug was unlikely to be determined given that it was discovered in a highly trafficked area of the West Wing. The small amount of cocaine was found in a cubby area for storing electronics within the West Exec basement entryway into the West Wing, where many people have authorized access, including staff or visitors coming in for West Wing tours. — Jan. 6 defendant who cased Obama’s neighborhood made week-long series of threats: A man arrested last week for breaching the Capitol on Jan. 6 drove a van full of weapons to Barack Obama’s neighborhood before his June 30 arrest, appearing to target the former president’s home after a Truth Social post from Donald Trump that identified the Obama family’s Kalorama address, prosecutors say. “[Taylor] Taranto used his own Truth Social account to re-post the address,” prosecutors wrote in court papers filed today. “On Telegram, Taranto then stated, ‘We got these losers surrounded! See you in hell, Podesta’s and Obama’s.’ Shortly thereafter, Taranto again began livestreaming from his van on his YouTube channel. This time, Taranto was driving through the Kalorama neighborhood of Washington D.C.” — Former Democratic congressman launches comeback bid for New York seat: Former Rep. Mondaire Jones announced today he will run for Congress in New York’s 17th Congressional District, setting up a highly anticipated comeback bid and a possibly tough Democratic primary in a key swing seat. Jones will face a Democratic primary against Liz Whitmer Gereghty, an education advocate and the sister of Michigan Gov. Gretchen Whitmer. Gereghty, who serves on a school board in the district, has been courting support from members of the Michigan congressional delegation and is expected to carve out a more moderate lane in the race. Democrats are anxious to flip the seat currently held by Republican Rep. Mike Lawler. Nightly Road to 2024 INDICTMENT WINDFALL — Donald Trump nearly doubled his fundraising during the second quarter of 2023 — an indication that his legal troubles are propelling his campaign financially, POLITICO reports. The former president’s joint fundraising committee raked in more than $35 million, according to a campaign official. That figure is about twice the $18.8 million the committee raised during the first quarter of the year. The joint fundraising committee is split between two entities: Trump’s official campaign, and his leadership political action committee, Save America. The total amount raised is likely to further cement Trump’s status as the frontrunner for the Republican nomination. It also underscores that the twin indictments he’s facing — with the possibility of more to come — are mobilizing his base of online donors. WHEN A WALL ISN’T ENOUGH — Republicans running for president and in Congress are coalescing around a controversial way to wage war against illegal drugs—sending the U.S. military into Mexico, the Wall Street Journal reports. Former President Donald Trump, who has previously called for building a wall along the southern border and giving drug dealers the death penalty, has also proposed creating a naval blockade of Mexico to prevent drugs like illicit fentanyl from entering the U.S. His leading opponent in the 2024 GOP nomination race, Florida Gov. Ron DeSantis, promised last week to use “deadly force” against anyone caught smuggling drugs across the border. There is a simple reason the idea of a military intervention keeps cropping up — it is popular, and not just with Republicans. In an NBC poll taken in late June, sending troops to the border to stop drugs was the single best-liked of 11 GOP proposals tested with Republican primary voters. And it was the only one that gained support from a majority of all registered voters. FULTON COUNTY CHRONICLES — The Republican Party in Georgia’s most populous county is suing local elected officials over the rejection of one of the party’s nominees to serve on the county election board, saying he was being punished for trying to clean up voter rolls, the AP reports. In the lawsuit filed Friday, the Fulton County Republican Party asks a judge to order the county Board of Commissioners to appoint Jason Frazier to the county Board of Elections and Registration. Fulton County, which includes most of the city of Atlanta, is a Democratic stronghold. Frazier has recently filed challenges to the eligibility of thousands of Fulton County voters. The GOP lawsuit notes that both state and federal law permit such challenges and his “demonstrated commitment to preserving the integrity” of the state’s elections makes him “uniquely suited to help the county’s election process.” That is why the county Republican Party nominated him to the election board, the suit says. AROUND THE WORLD Poland's Prime Minister Mateusz Morawiecki arrives for the European Council Summit, at the EU headquarters in Brussels, on June 29. | Ludovic Marin/AFP via Getty Images FRAUGHT RELATIONSHIP — The EU today criticized Poland’s lack of progress on judicial reforms, adding fuel to the already fiery relationship between Warsaw and Brussels, Gregorio Sorgi reports. The European Commission raised “serious concerns” about the independence of the Polish judiciary in its annual report on the rule of law, noting that the country ignored most of the EU’s recommendations from the previous year. With less than six months to go until Poland’s tightly contested elections, where the nationalist government risks losing power after eight years in office, the report will shed a harsh spotlight on the tensions between Warsaw and Brussels under the ruling Law and Justice party. Already, Brussels is withholding billions from Warsaw in a long-running rule-of-law dispute — a fight the Polish government has tried to spin to its political advantage but that nonetheless presents domestic challenges. There’s also a looming battle between the two over a recent migrant relocation deal Poland has vowed to boycott.   STEP INSIDE THE WEST WING: What's really happening in West Wing offices? Find out who's up, who's down, and who really has the president’s ear in our West Wing Playbook newsletter, the insider's guide to the Biden White House and Cabinet. For buzzy nuggets and details that you won't find anywhere else, subscribe today.     Nightly Number $8.1 million The amount of money that Rep. Adam Schiff (D-Calif.) raised in the second quarter as he campaigns for U.S. Senate. Schiff, the impeachment manager who recently received a censure from House Republicans, broke the Senate quarterly fundraising record of Sen. Raphael Warnock (D-Ga.), who raised $7.2 million in the second quarter of the off-cycle in 2021. Schiff had more than 144,000 unique donors over the quarter who made more than 233,000 donations from 50 states and all of California’s 58 counties. RADAR SWEEP VIOLIN VIOLENCE — In 2021, a 62-year-old man named Bernard Raymond von Bredow and his 14-year-old daughter were murdered and likely tortured by thieves looking for certificates of authenticity to four Stradivarius violins in their possession. Von Bredow, described by his friends as an eccentric with a penchant for collecting and restoring fancy violins, was living in Paraguay but was of German descent. The suspects in his and his daughter’s murder, due to his collection and his personal history, were numerous. In his own life, he became increasingly interested in dark conspiracy theories related to Bill Gates and George Soros. After he died, stories about the man and his strange life continued to spill out. And though two people were arrested for his murder, that’s only the beginning of the strange story. Brent Crane reports for Bloomberg. Parting Image On this date in 2006: South Korean protesters burn a picture of depicting North Korean leader Kim Jong-il and North Korea's flag during an anti-North Korea rally in Seoul. North Korea had just test-launched six missiles including a long-range missile in an early morning barrage, defying stern international warnings of retaliation. | Lee Jin-man/AP Photo Did someone forward this email to you? Sign up here.   Follow us on Twitter Charlie Mahtesian @PoliticoCharlie Calder McHugh @calder_mchugh Katherine Long @katherinealong   Follow us

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