Hospice Patients Alliance: Consumer Advocacy


It is well-known that there are problems in the health care industry. From the government and private-insurance perspective, health care costs are increasing too quickly and bills for services are simply too high. On the other hand, health care workers are paid less than comparably trained workers in other fields. Nurses especially are underpaid. Part of the reason is that the vast majority of nurses are women, and women historically, in our society, have been paid less than men for similar work. And many health care workers enter the field out of a sense of service to humanity and caring. For that reason, some feel that they are giving of themselves for a worthy cause, even if under paid.

Even though many health care staff are underpaid, top and middle-level executives of large health care and pharmaceutical corporations routinely receive salaries in the hundreds of thousands of dollars, even millions. Costs for medications, and equipment continually go up. Corporations double-bill for services, medications and equipment. Even bills which are not totally fraudulent, frequently contain inflated charges for itemized expenses. These inflationary trends are one reason for health care costs to spiral upward.

The health care field is mostly administered by businesses which aim at cutting their own costs and increasing profits (increasing costs to others). They are no longer controlled by people truly dedicated to the mission of serving others for service's sake. Self-interest and the benefit to corporate shareholders has taken over the administration of the industry. Even nonprofit health care corporations must take in more than they spend in order to stay in business. The competitive nature of business has progressively entered into health care, so that decisions are made based on short-term business goals rather than the good of the community or ethical considerations. When shareholders' business interests control the decision-making process, to the exclusion of ethical and legal considerations, short cuts are taken which result in suffering for patients, families, care givers and health care staff.

Fraud in health care is rampant. For this reason, the U.S. Office of Inspector General (OIG) has launched its Operation Restore Trust. A Fraud Hotline has been established and hundreds of thousands of complaints have been phoned in to the U.S. OIG offices. There is now a large backlog of cases to be investigated and prosecuted. The OIG has hired many new special agents to investigate all the cases of health care fraud.

One well-known intentional violation agencies routinely commit is understaffing their facilities. The law specifies minimum staffing which must be maintained, but agencies look the other way and assign fewer staff to their facilities anyway. Under-staffing at hospitals is a well-known tactic used to increase the bottom line while patient care deteriorates. The reasoning? If we can get by and provide the services with less expenditure for staffing, so much the better, our profits will increase and the shareholders will be pleased. Are the best interests of the patients the controlling factor? Certainly not!

If a patient suffers, large health care corporations do not really care, so long as the corporation is making money. They do not intend to harm the patients, but they make decisions which they know will result in harm to patients. They consider even a few lawsuits acceptable risks to take on the road to big profit margins. And when the big profit margins arrive, they reward themselves with fat salary increases on a yearly basis while cutting salaries and/or benefits to the staff that directly serve the patients. They replace full-time experienced workers with two or three part-time workers without experience. The part-timers do not get benefits quite often, and their hourly wages will be less than the senior, more experienced workers who have been replaced.

Health care corporations have been steadily replacing more highly trained professionals with untrained technicians who get trained on the job for specific tasks or procedures. Physicians are replaced with nurses; nurses are replaced with technicians; registered nurses are replaced with licensed practical nurses or aides. The result? Patient care quality suffers. Of course, none of this is admitted publicly. Public Relations representatives are hired to make all decisions appear to be made for the welfare of the public.

How many HMO's (Health Maintenance Organizations) pay their top executives millions of dollars while patients are denied care they are entitled to receive? Many. This state of affairs is a disgrace and threatens to destroy the fine health care system we have in the United States. If this trend continues, only the very rich or poor will get health care, while the working middle-class may have to accept whatever health care they can get from corporate health plans, if they have any health benefits at all.

Hospices can and do play the same games of cutting corners. Hospice administrators may assign more cases to their staff than can reasonably be managed well...to increase profits. RN case managers, social workers, chaplains, counselors, and home health aides may struggle to cover all the cases they have. Fewer staff hired means smaller payrolls and less expense. Result The hospice saves money. Quality suffers...but who will know the difference? If there's a complaint, the administration can blame the staff and intimidate them...which often is done. Staff fear losing their jobs, so they keep quiet and do the best they can, slowly burning out emotionally in the process.

Of course, ethical administrators will not reward themselves with obscene salaries in the hundreds of thousands of dollars or even millions while patients go without basic care. Not providing the care according to the standards saves the health care agencies money, but violates the law. Most agencies who commit fraud obviously believe that they will not get caught. They also believe that even if they do get caught, the penalties will not be severe, they can plea bargain their way out of it or make a show of correcting the problem by terminating some middle-managers who will take the blame.

Unethical administrators do exactly this every day in the United States! Our health care system must be reclaimed from the white-collar criminals who commit fraud knowingly, while patients suffer. Only by filing formal complaints with the U.S. Attorney's Office and the U.S. Office of the Inspector General will health care fraud be stopped. The public must become actively involved in protecting itself and enforcing the standards of care, whether in hospice or other health care. The time for consumer advocacy in health care and hospice in particular has arrived.

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