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Can A Hospice Be Responsible for Neglect?
Quick Answer
Yes, a hospice provider can be held responsible for neglect in Arizona. Hospices must follow a written plan of care, make the visits that plan requires, control pain and symptoms, and coordinate with any nursing home or assisted living facility where the patient lives. When a preventable injury, unnecessary suffering, or death results from a failure to do those things, a family may have a claim.
What Is Hospice Neglect?
Hospice neglect is a failure to provide the care the hospice agreed to provide under the patient’s plan of care and under Medicare’s hospice rules. Hospice is care focused on comfort rather than cure.
A patient dying on hospice is expected. Suffering that could have been prevented is not. Neglect is about the quality of the dying process, not the fact of death.
Hospice care happens in three places: in the patient’s own home, inside a nursing home or assisted living facility, and in a freestanding inpatient hospice unit. Neglect can happen in all three.
Common Types of Hospice Neglect
Missed or shortened visits
The plan of care sets how often nurses, aides, social workers, and chaplains should visit. Weekends, holidays, and nights are common gaps.
Uncontrolled pain and symptoms
Ongoing pain, shortness of breath, agitation, or nausea that is not reassessed and treated can be a sign that the care fell short.
Bedsores and untreated wounds
Bedsores (also called pressure injuries) develop when a person who cannot move stays in one position too long. They are largely preventable with repositioning, the right mattress, and skin checks, and they worsen quickly when no one is watching. See our page on bedsores page and our article on the hidden dangers of bedsores in nursing homes.
Falls
A fall after the risk was known and no precaution was taken raises the question of whether the injury was preventable. See falls page.
Dehydration and poor feeding
Some patients stop eating as the end approaches, and that is a normal part of dying. Missed mouth care, no help with meals, or a neglected feeding tube are not.
Medication errors and medication theft
Hospice patients take strong medications, including opioids (powerful prescription painkillers). Wrong doses, late doses, and missing doses are errors. Controlled drugs that go missing, called diversion, can leave a patient without pain relief. See medication errors page.
Failure to recognize or report abuse by others
Hospice staff see patients regularly. Whether they noticed and reported signs of abuse by someone else is a fair question.
Improper enrollment or improper ”live discharge”
Some patients are enrolled who are not terminally ill. In other cases a hospice drops a patient (a live discharge) and leaves the family without support.
What federal investigators have documented
In 2019, the U.S. Department of Health and Human Services Office of Inspector General (HHS-OIG) published ”Safeguards Must Be Strengthened To Protect Medicare Hospice Beneficiaries From Harm” (report OEI-02-17-00021). It described 12 cases of serious harm to hospice patients, including heel wounds that turned gangrenous and led to a leg amputation, maggots around a feeding-tube site, inadequate pain management, missed signs of possible sexual assault, and repeated theft of a patient's medications. Of the 12 cases, only one hospice reported the harm to CMS (the Centers for Medicare & Medicaid Services).
Hospice Inside a Nursing Home: Who Is Responsible?
Many Arizona hospice patients live in a nursing home or assisted living facility. That means two providers are involved: the hospice and the facility. When something goes wrong, each often points at the other.
Federal law does not leave this to chance. Under 42 CFR 418.112, when a hospice patient lives in a nursing facility, the hospice and the facility must have a written agreement, signed by both before hospice services begin. The rule requires that agreement to cover, among other things:
- How the two will communicate, including a way to reach each other 24 hours a day, and how those communications are documented.
- The facility’s duty to notify the hospice promptly of significant changes in the patient’s condition, clinical complications, and other events the rule lists.
- Who provides what: the hospice’s responsibilities (medical direction, nursing, counseling, social work, drugs and supplies for comfort) and the facility’s responsibility for room, board, and personal and nursing care.
- The hospice’s duty to report alleged abuse, neglect, or misappropriation of a patient’s property to the facility administrator within 24 hours of becoming aware of it.
Why Hospice Quality Is a Concern in Arizona
Arizona has seen fast growth in the number of hospices since 2018, much of it for-profit. A ProPublica analysis of Medicare data and its reporting with The New Yorker found that Arizona had seen hospice growth that far outpaced demand.
In April 2023, a group of hospice and palliative-care physicians published a statement in the Journal of Palliative Medicine on the core roles of physicians in hospice. It described warning signs of low-quality care, including a hospice with no functioning care team and little physician involvement with patients.
Warning Signs Your Loved One Is Being Neglected by Hospice
- Nurse or aide visits are fewer than promised, or no one comes when you call
- Your loved one seems to be in constant or worsening pain
- New or worsening bedsores, strong odors, or soiled bedding
- Medications run out, go missing, or doses do not match orders
- Rapid weight loss or signs of dehydration
- Staff cannot tell you what the plan of care says
- Nursing home staff and hospice staff give conflicting explanations
What Families Should Do If They Suspect Hospice Neglect
- Write down dates, missed visits, names, and what you were told.
- Photograph wounds and conditions, with care and respect for your loved one.
- Ask for the hospice plan of care and visit notes. If your loved one lives in a facility, ask for the facility records too.
- Report your concerns police, to Arizona Adult Protective Services, and to ADHS (which licenses hospices).
- Most importantly, talk to an attorney early, before records are changed or a deadline runs.
Hospice Neglect FAQs
Can you sue a hospice for neglect in Arizona?
Yes, a hospice may be held responsible when its failures cause preventable harm. A claim can rest on Arizona’s Adult Protective Services Act or ordinary negligence. Whether a case exists depends on what the records show.
If my loved one was going to die anyway, do we still have a case?
Possibly. Hospice neglect is about preventable suffering, not the fact of death.
Who is responsible when hospice care happens inside a nursing home?
The hospice, the facility, or both. Federal rules require a written agreement and a coordinated plan of care that say who does what, and the records often show where the plan broke down.
What if the hospice missed scheduled visits?
Write down each missed visit and ask for the visit log and plan of care. We compare them with what the plan required.
Can a hospice be liable for undertreating pain?
It can be, if the records show pain was not assessed, reported, or treated as the plan of care and medical orders required.
Can a hospice discharge a patient without warning?
Medicare limits when a hospice may discharge a patient, and families are entitled to notice and to help finding other care.
How do I report hospice neglect in Arizona?
Report to the police, Adult Protective Services, and to ADHS licensing (which handles complaints against hospices)
Contact Solomon & Relihan for a free case review. Call (602) 387-3000.
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