As an attorney who focuses on holding long-term care facilities accountable for negligent care and abuse of the sick and elderly, I often represent clients who were placed on palliative care, or hospice services. These cases often involve the failure of the skilled nursing facility to provide adequate care to my clients prior to their passing. Litigation of these cases inevitably leads to presenting my client’s surviving children and/or spouse for sworn depositions.

The attorneys who represent the defendant nursing homes tend to bring up the fact that the resident “was on hospice,” if this was documented in their medical record. In questioning my client’s loved ones, they often explore why the survivors decided to place their elderly family member on hospice. The motive behind the move by defense counsel is apparent—they want the surviving daughter or son to feel as if they were the ones who decided to reduce the level of care given to their parent. In other words, they want to plant a seed of blame in the witness’s mind for anything that might have occurred from lack of care, since they “agreed” to less care.

However, those witnesses often testify that the nursing home explained that putting their parent/spouse on hospice actually causes them to get a higher level of nursing care. When the witness testifies in this manner, defense counsel will often ask, “Didn’t they explain that no curative care is provided in hospice?” My clients agree but insist that the facility employees implied that this results in more individualized attention and therefore, better care.

Author Ava Kofman, of ProPublica, recently published, Endgame: How the Visionary Hospice Movement Became a For-Profit Hustle. In her article, she confirms how individuals may be pressured into hospice care, as my clients testify, and reveals the dark side of the industry: Patients are promised better care. Admissions coordinators may be given cash bonuses for signing up new hospice patients. Doctors may sign blank forms certifying that individuals they have never examined are eligible for hospice. Patients may be enrolled in hospice care without their knowledge. Administrators may order nurses to intentionally overdose patients that are reaching their limits, to avoid paying the government back for hospice services. 

To be clear, hospice is a viable option for some who have a terminal condition. However, one should fully understand exactly what care will and will not be provided when deciding to switch to palliative care. Anyone who is considering hospice care for themselves or a loved one, should read this article.