Analysis: Many hospices fail patients just before they die

When hospice patients have chosen to die at home, as they typically do, the days immediately before death are usually the hardest, and the time when families most need a visiting nurse.

But many U.S. hospices regularly fail to send a nurse to patients in the two days preceding death, according to a Washington Post analysis of Medicare records.

About one in five U.S. hospices does not send a nurse to patients during that critical time for at least 20 percent of patients, according to the data.

Families who have had to handle a loved one's dying days without nursing help have referred to their hospice experience as "do-it-yourself death."

Some patients die without warning, of course, and naturally almost every hospice has some patients who die without having had a recent visit. But at a typical hospice, only about 8 percent of patients die that way.

When a hospice more regularly fails to send a nurse out during that window, experts said, the hospice probably isn't responding to patient needs. Indeed, the statistic - the percentage of patients at a hospice who die without a recent nursing visit - is considered by some a good indicator for quality.

For patients and families, being unable to see a nurse at critical moments can be excruciating.

- Washington Post