GAO issued a report on December 12, 2022, that identified gaps in the reporting requirements for hospice abuse and neglect allegations as compared with requirements for extended care provided in hospitals and nursing homes. Hospice care addresses the physical and emotional needs of individuals with terminal illnesses. This care is most often provided in private homes, but can also be provided in hospitals, nursing homes, or other settings.

Hospices are required to report allegations of abuse and neglect to the state agencies responsible for monitoring them if: (1) the alleged perpetrator is affiliated with the hospice; and (2) the hospice has verified the allegation as abuse or neglect based on an internal investigation that may take up to five days. In contrast, nursing homes and hospitals providing extended care are required to report all abuse and neglect allegations prior to conducting an internal investigation, regardless of whether the alleged perpetrator is affiliated with the hospice.

As a result, hospice care providers’ reporting may be less complete or timely than that of nursing homes and hospitals providing extended care. For example, hospices are not required to report allegations involving alleged perpetrators not affiliated with the hospice even though research suggests that most abuse of older individuals is committed in the home by an individual’s caregivers, such as family members. Therefore, GAO recommended in the report that CMS require hospice care providers to report all allegations of abuse and neglect immediately to survey agencies, regardless of whether the alleged perpetrator is affiliated with the hospice.