Complaints About Hospice Care in the United States, 2005-2015

Background: Complaints are an opportunity for patients and family members to report allegations of substandard care. No prior studies have examined complaints in hospice care and what might be learned from them. Objectives: To describe hospice complaint trends, characterize state investigation practices, and assess the relationship between complaints and hospice agency traits of interest. Methods: Retrospective analyses merged hospice complaints from 2005 to 2015 with agency characteristics from Medicare Cost Reports and Provider of Service files. Measurements: Annual rates of complaint allegations and deficiencies on a per agency and per 10,000 patient days basis, nationally and by state. Likelihood of having any complaint allegations and deficiencies. Mean days to investigation and substantiation rates, by state. Hospice traits of interest were accreditation and profit status. Results: Between 2005 and 2015, a total of 12,931 complaint allegations were received about hospice care, resulting in 6710 complaint deficiencies. Allegations centered on concerns about quality of care (45%), patients' rights (20%), and administrative/personnel concerns (14%). Complaint rates varied across states but were generally quite lowin a given year, 88% of agencies nationally did not have any complaints. Complaint investigation practices varied considerably across states, with 34% of complaints substantiated. For-profit agencies were 1.33 and 1.52 times more likely relative to not-for-profits to have a complaint allegation and deficiency, respectively. Conclusions: Although the number of complaints was low overall, these data have the potential to convey insights about the care that hospice agencies provide. Greater attention to the perspectives of patients and their families, even when focused on shortcomings in care, can help ensure transparency and accountability and promote higher quality hospice care.