HHS Inspector General Finds Serious Flaws In 20% Of U.S. Hospice Programs
From 2012 through 2016, federal health inspectors cited 87% of U.S. hospices for deficiencies. And 20% percent had lapses serious enough to endanger patients, according to two new reports from the HHS Inspector General’s office.
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We all hope for some peace and comfort at the end of life. Hospices are designed to make that possible, relieving pain and providing emotional and spiritual support. But two new government studies released Tuesday morning find that the vast majority of hospices have sometimes failed to do that.
And there’s no easy way for consumers to distinguish the good hospices from the bad.
The reports are the government’s first to look at hospice deficiencies nationwide. The Office of the Inspector General in the Department of Health and Human Services found that from 2012 through 2016, health inspectors cited 87% of hospices for deficiencies. And 20% percent of hospices had lapses serious enough to endanger patients.
Deputy Regional Inspector General Katherine Harris cites the case of a patient who had untreated bed sores, or pressure ulcers, on both heels.
“These ulcers rapidly worsened,” says Harris. “The patient developed gangrene and needed a leg amputation.”
In the dry terminology of government reports, this is called “poor care planning.” And having plans of care developed in conjunction with the patient and the patient’s family, Harris says, is a fundamental requirement of hospice,.
“So when we discover that hospices are not doing them, there is reason for concern,” she says.
For example, there’s the case of Karen Bishop Collings and her 85-year-old dad, Dean Bishop. Though Bishop had chronic lung disease, he’d been doing OK and living independently. Then, last winter, he was hospitalized with pneumonia. When he was transferred to a residential care facility to recuperate, he began receiving hospice services. That was a surprise to his daughter.
“We only agreed to pre pre-assessment of his conditions, to even see if he qualified for hospice or palliative care,” she says.
Collings has shared some of her father’s medical records with NPR, and they verify her recollection. The hospice never held a meeting with Bishop or the family to establish a care plan. So Collings was shocked when hospice workers gave her father two new medications: morphine and the anti-anxiety drug Ativan.
“We knew something distressing had happened,” she says. “His whole physicality and mental capacity was completely altered.”
Dean Bishop died a couple of days later.
If this hospice had previously been cited for deficiencies, Collings would have had a hard time finding out. The Centers for Medicare and Medicaid Services, or CMS, doesn’t make that information available on Hospice Compare, its website for consumers, even though the agency has the authority to post at least some of that data.
“We live in a time when we don’t even think about booking a hotel without checking its ratings and reviews,” says Harris. “Why do we demand less for hospices?”
The reports also highlight the the options CMS has for disciplining hospices are few. The agency can drop substandard hospices from the Medicare program altogether. But it lacks the legal authority to assess fines. It would take an act of Congress to give CMS that power.
In response to the Inspector General’s reports, CMS issued a written statement that the agency “has zero tolerance for abuse and mistreatment of any patient.” The statement also says that the agency has added consumer feedback to the Hospice Compare website. Katherine Harris thinks that’s not enough.
“There are a lot of great hospices out there,” Harris says. “There are a lot of highly skilled, committed professionals who are dedicated to helping others leave this life in comfort and with dignity — and the public should know about them.”
The amount of money that Medicare spends on hospice services has roughly doubled since 2006. But Harris says this isn’t just a matter of taxpayer dollars.
You’re only going to die once, she says. It’s important that things go right.
HHS Inspector General Finds Serious Flaws In 20% Of U.S. Hospice Programs
From 2012 through 2016, federal health inspectors cited 87% of U.S. hospices for deficiencies. And 20% percent had lapses serious enough to endanger patients, according to two new reports from the HHS Inspector General’s office.
sturti/Getty Images
hide caption
toggle caption
sturti/Getty Images
We all hope for some peace and comfort at the end of life. Hospices are designed to make that possible, relieving pain and providing emotional and spiritual support. But two new government studies released Tuesday morning find that the vast majority of hospices have sometimes failed to do that.
And there’s no easy way for consumers to distinguish the good hospices from the bad.
The reports are the government’s first to look at hospice deficiencies nationwide. The Office of the Inspector General in the Department of Health and Human Services found that from 2012 through 2016, health inspectors cited 87% of hospices for deficiencies. And 20% percent of hospices had lapses serious enough to endanger patients.
Deputy Regional Inspector General Katherine Harris cites the case of a patient who had untreated bed sores, or pressure ulcers, on both heels.
“These ulcers rapidly worsened,” says Harris. “The patient developed gangrene and needed a leg amputation.”
In the dry terminology of government reports, this is called “poor care planning.” And having plans of care developed in conjunction with the patient and the patient’s family, Harris says, is a fundamental requirement of hospice,.
“So when we discover that hospices are not doing them, there is reason for concern,” she says.
For example, there’s the case of Karen Bishop Collings and her 85-year-old dad, Dean Bishop. Though Bishop had chronic lung disease, he’d been doing OK and living independently. Then, last winter, he was hospitalized with pneumonia. When he was transferred to a residential care facility to recuperate, he began receiving hospice services. That was a surprise to his daughter.
“We only agreed to pre pre-assessment of his conditions, to even see if he qualified for hospice or palliative care,” she says.
Collings has shared some of her father’s medical records with NPR, and they verify her recollection. The hospice never held a meeting with Bishop or the family to establish a care plan. So Collings was shocked when hospice workers gave her father two new medications: morphine and the anti-anxiety drug Ativan.
“We knew something distressing had happened,” she says. “His whole physicality and mental capacity was completely altered.”
Dean Bishop died a couple of days later.
If this hospice had previously been cited for deficiencies, Collings would have had a hard time finding out. The Centers for Medicare and Medicaid Services, or CMS, doesn’t make that information available on Hospice Compare, its website for consumers, even though the agency has the authority to post at least some of that data.
“We live in a time when we don’t even think about booking a hotel without checking its ratings and reviews,” says Harris. “Why do we demand less for hospices?”
The reports also highlight the the options CMS has for disciplining hospices are few. The agency can drop substandard hospices from the Medicare program altogether. But it lacks the legal authority to assess fines. It would take an act of Congress to give CMS that power.
In response to the Inspector General’s reports, CMS issued a written statement that the agency “has zero tolerance for abuse and mistreatment of any patient.” The statement also says that the agency has added consumer feedback to the Hospice Compare website. Katherine Harris thinks that’s not enough.
“There are a lot of great hospices out there,” Harris says. “There are a lot of highly skilled, committed professionals who are dedicated to helping others leave this life in comfort and with dignity — and the public should know about them.”
The amount of money that Medicare spends on hospice services has roughly doubled since 2006. But Harris says this isn’t just a matter of taxpayer dollars.
You’re only going to die once, she says. It’s important that things go right.
U.S. Women To Resume ‘Equal Pay For Equal Pay’ Fight After Winning 4th World Cup
The U.S. Women’s National Team won the Women’s World Cup championship for a fourth time. As the players return home, they’re ramping up their fight for “equal pay for equal play.”
ARI SHAPIRO, HOST:
The celebration for the U.S. Women’s National Soccer Team shifts this week from France to New York City. On Wednesday, the World Cup champs will get a ticker-tape parade and keys to the city. Then the players will turn their focus back to a more serious matter. In a lawsuit filed before the tournament, they demanded equal pay to their male counterparts. As NPR’s Tom Goldman reports, many U.S. women’s team supporters say a fourth World Cup title makes the case even stronger.
TOM GOLDMAN, BYLINE: In the stadium in Lyon yesterday, it didn’t take long for the pivot from joy to indignation. As U.S. players hugged and celebrated their hard-earned victory over a tough Netherlands team, the chants bubbled up from the stands.
(SOUNDBITE OF ARCHIVED RECORDING)
UNIDENTIFIED SOCCER FANS: (Chanting) Equal pay, equal pay, equal pay.
GOLDMAN: And then the booing…
(BOOING)
GOLDMAN: …For members of FIFA, soccer’s international governing body, which reportedly will pay the U.S. women a $4 million bonus, compared to the 38 million it paid to last year’s men’s World Cup winners.
Megan Rapinoe, the outspoken U.S. winger, won the Golden Ball award given to the tournament’s most valuable player. But after the match, she assumed her other role as outspoken plaintiff in the class-action suit filed against the U.S. Soccer Federation in March. The suit was brought by U.S. players, but Rapinoe says everyone at this World Cup helped push the fight forward.
(SOUNDBITE OF ARCHIVED RECORDING)
MEGAN RAPINOE: Every player at this World Cup put on the most incredible show that you could ever ask for, and we can’t do anything more to impress, more to be better ambassadors, to take on more, to play better, to do anything. It’s time to move that conversation forward to the next step.
GOLDMAN: The next step is mediation, as the U.S. women and their federation try to resolve issues of equal pay and better working conditions. On the surface, resolution seems easy; pay the U.S. women what the U.S. men make. Look at the women’s success versus the men’s lack thereof. The men didn’t even qualify for their last World Cup. Look at what the teams make for their federation. The Wall Street Journal reports in the last three years, U.S. women’s games generated more revenue than the U.S. men.
Still, sports law expert Michael McCann says resolving the issues is tricky.
MICHAEL MCCANN: It’s a complex topic. It’s not as straightforward as I think it’s depicted.
GOLDMAN: McCann is a law professor at the University of New Hampshire. He says there’s debate about how revenue is attributed to the men’s and women’s teams. There’s debate about how sponsorships are awarded. The two teams have different pay structures. The men are paid when they play. The women have guaranteed pay. And McCann wonders what happens if the women are successful in their efforts.
MCCANN: Here, this is an entire group of players bringing in a case over pay. That complicates it in the sense that – how would any increases be distributed?
GOLDMAN: McCann says the lawsuit is suspended during mediation. But if talks fail, the women will resume litigation. Emily Martin says women everywhere in this country should pay attention to this case over pay inequality. Martin is with the National Women’s Law Center. She says when you compare women and men who work full time, women are paid about 80 cents for every dollar paid to men.
EMILY MARTIN: I do think it will inspire individual women to come forward and say, pay me what you owe me. I also think that when you see this kind of high-profile excellence fighting for equal pay, that that is an important prompt for lawmakers to do the same.
GOLDMAN: Martin adds, considering the U.S. women’s sustained excellence, maybe pay equality is aiming too low and it’s time to ask for better pay.
Tom Goldman, NPR News.
(SOUNDBITE OF MUSIC)
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How João Gilberto’s Music Sparked An Aesthetic Revolution
João Gilberto in 1970
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From a casual distance, the music of João Gilberto sounds like it might belong to that ancient realm known as “easy listening.”
Everything’s calm, for starters. Even at fast tempos, Gilberto’s voice demands nothing — hushed, thin, confession-booth quiet. His rhythm guitar anchors the music with accompaniment that can seem almost hypnotically repetitive. The melodies rarely beg for attention, instead basking in that sublime mix of contentedness and yearning common throughout Brazilian music. There are strings rising up in wave-like swells from time to time, and lamenting love calls from the low brass.
Beneath that smooth and pleasant veneer, Gilberto built a quiet (and still misunderstood) aesthetic revolution – a lithe, strikingly modern approach to rhythm and melody that became the blueprint for bossa nova.
Gilberto, who died at home in Rio de Janeiro on Saturday, was best known for his contributions to Getz/Gilberto, the 1964 album that, through its single “The Girl From Ipanema,” made bossa nova a worldwide sensation (and won the Grammy for album of the year). But Gilberto deserves to be remembered more broadly, as a kind of patron saint of understatement, whose early recordings transformed the boisterous celebration of samba parades into music of arresting intimacy.
The rare instrumentalist (i.e., not a composer) to define and shape a musical genre, Gilberto developed an austere, steady-handed revolution that opened up lanes of exploration for subsequent generations. And it swept like wildfire, becoming pervasive before he could even be properly acknowledged as its spark plug. (“Eventually the culture caught up to him, and despite his reputation as a recluse, he became a revered figure in Brazil — referred to as “O Mito/The Master” and “O Rei da Bossa/The King of Bossa” and “Ill Mastro Supremo,” and, perhaps most fittingly, “O Zen-Baiano/The Zen Master of Bahia.”)
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Those early recordings, particularly his 1958 take on Antonio Carlos Jobim’s “Chega de Saudade/No More Blues,” had a meteor-like impact on the musicians of Brazil; Gilberto’s blend of whispering vocals and exactingly precise guitar accompaniment represented a radical break from the schmaltzy pop balladry (Nelson Gonçalves, for example) on the radio at the time. Guitarist Oscar Castro-Nieves recalled hearing that single for the first time as a teenager: “It changed everything, for every young musician in Brazil … all I can say is that it was like the first time I heard Charlie Parker.”
The singer and songwriter Caetano Veloso, another legendary Brazilian singer and songwriter whose discography elaborates on Gilberto’s basic themes, was even more effusive in an L.A. Times interview: “I owe João Gilberto everything I am today. Even if I were something else and not a musician, I would say that I owe him everything.”
Gilberto’s stealth approach was born after several unsuccessful attempts to establish himself as a musician for hire in Rio, where, according to legend (as relayed in Ruy Castro’s authoritative history of bossa nova, Chega de Saudade), he overstayed his welcome on the couches of friends. He fled to his sister’s house, in a town called Diamantina, where, in a tile bathroom with favorable acoustics, he began to experiment with a sound built around brooding, vibrato-free and leisurely, long-toned vocals.
In a rare interview with the New York Times in 1968, Gilberto explained that his process involved editing out all but the most essential information. “It has to be very quiet for me to produce the sounds I’m thinking of.”
Gilberto’s central innovation, overall, was in the guitar accompaniment. Gilberto took the massive rhythm of the samba schools he heard growing up in Bahia – a thrilling sensory experience involving hundreds of drums, superloud shakers and clanging metal bells locked together in endlessly propulsive polyrhythm – and distilled it down to stark human scale. Music centered around one voice and one acoustic guitar.
“Rosa Morena”
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Typically, such a reduction of forces diminishes — but Gilberto’s reduction had the opposite effect, opening up a new resonance for samba, using the form’s rhythmic intensity to uncover hidden directions and nuances. First, Gilberto caught the whomp of the samba bass drum with his thumb. Then, with his other fingers moving independently, he’d stab against the time with crisply articulated chords, forming an artful, unpredictable syncopation. These patterns can sound like recurring loops (Gilberto’s time is astonishingly steady) but as you listen more closely, they register as constantly evolving codes. You can hear him varying the cadences, the length of the patterns, the voicings. The result: An ever-changing, mosaic-style backdrop, a guitar-powered perpetual motion machine. (“Rosa Morena” is a good example of this.)
“Brigas, Nunca Mais”
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“Doralice”
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Over this, Gilberto sang in a placid, straightforward style that sometimes masked the turbulence underneath (as on “Brigas, Nunca Mais”), and sometimes sharpened it (as on “Doralice”). Having turned the extroversion of samba inward, he went about exploring distinct shades of emotion, adding dimension and richness to beloved early samba classics by subtracting the pageantry.
In performances and recordings from the 1970s, Gilberto began stretching out melodic phrases in whimsical, sometimes radical ways; it could be disarming to hear such a languid, vapor-like voice creating tension just by reconfiguring the commonly understood shape of a familiar melody.
Those explorations align Gilberto with artists like Bob Dylan, whose ad-libbing confounded expectations in the quest for newly resonant interpretations. More broadly, Gilberto’s austere, modernist approach connects to artistic movements outside of Brazil, most notably jazz. In both his guitar work and his singing, Gilberto was a master improviser, and his less-is-more philosophy mirrors those of Miles Davis and Thelonious Monk. As they did, Gilberto pared excess language and stylistic flourishes to the bare minimum, on a quest to uncover nuances by subtraction.
As the “new” trend of bossa nova rose in the early ’60s, Gilberto became popular with a rising generation of songwriters. He introduced hundreds of songs that drew from samba while adding richly literary perspective on romance and devotion. These form the core of an extraordinary multi-generational Brazilian songbook that begins with the work of the prolific Antonio Carlos Jobim in the 1950s and ’60s, along with tunes by Veloso, Edu Lobo and others active in the late ’60s as well as stars of the ’70s like Milton Nascimento and Djavan. All of these share a common thread — the neatly syncopated performance style of Joao Gilberto. His crystalline renditions of “Corcovado” and “Caminhos Cruzados” (and countless other Jobim gems) taught subsequent generations of singers and instrumentalists how to approach the composer’s sophisticated harmonies, how to convey meaning with the slightest of gestures, how to create the kind of openness that draws the listener into the deep poignance of a tune.
The remarkable thing about João Gilberto is how often he managed this sublime art, under all kinds of musical conditions. His discography includes quietly transfixing recordings across a range of hues, from the upbeat to the meditative. And whether he’s working with a lush studio orchestra or playing alongside a lone percussionist, he rarely sounds like he’s exerting himself. Everything flows, effortlessly. He approaches the music as though sneaking or sliding into it. He’s coy, and wily, sculpting drop-dead gorgeous melodies out of shallow breath, dispensing intricate staccato samba codes with the grace of a dancer.
It is, from a distance, easy listening – the sound of serenity and calm, as steady as the sea. Let it get under your skin for a while, and the nuances blossom into complexities, the complexities breed more levels of nuance… and, pretty soon, it’s like being flattened by a feather.
