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NHPCO Response to KHN/Post

Edo Banach Responds to Kaiser Health News

August 22, 2017

Dear Editor:

There is no question that the U.S. is coping with an opioid epidemic of overwhelming proportions. Unfortunately, the article from Kaiser Health News published in The Washington Post, “Dying at home in pain doesn’t keep relatives from stealing the pills,” unfairly points to the hospice community’s role in exacerbating this national crisis.  That could not be further from the truth.  Hospices take seriously their obligation to maintain the health and safety of patients and their loved ones.  Hospices have an obligation to the community and the patient to be sure that the medications are used appropriately, which includes careful monitoring of the patient’s pain and the family and home situation. However, hospices – and those who work for them – generally do not have the authority to confiscate or destroy unused opoids or other pills.   

 As the author states, “The U.S. Drug Enforcement Administration encourages hospice staff to help families destroy leftover medications, but the agency forbids those staff members from destroying the meds themselves unless that is allowed by state law.”  I think it’s important to be perfectly clear, in most states, hospice professionals cannot touch the medications of a patient who has died – they belong to the family.  At the same time, Federal regulations require hospice professionals to go over the federal drug disposal guidelines with family caregivers, but hospice professionals are prohibited from taking a more active role in disposing or removing medications from the home.

Some states have taken action to put more control in the hands of the hospice professionals, but NHPCO supports a national policy and uniform set of practices.  To this end, NHPCO has already drafted legislation and has been working with Congress to expand the ability of hospice professionals to take a more active role in helping families dispose of these drugs.

Hospice professionals are trained in engaging with families about these medications – this includes addressing concerns of diversion or theft. Certainly, there are situations where a hospice professional failed, but such an instance should not be used to describe the entire provider community in this country. The 2013 study out of Virginia cited in the article, which reflects the practices of 23 hospices in Virginia, ultimately lead to training and resources made available throughout the state and country.

The author’s assertion that “hospices may go years without inspection” is not accurate. Legislation passed in 2014 (the IMPACT Act of 2014), strongly supported by the hospice community, requires hospices to be surveyed at least every three years. The hospice community has long worked with regulators to ensure high standards of practice, compliance and safety in the field.

Drug diversion by friends, family members and caregivers must be addressed. However, readers of this article who may have a loved one in hospice – or be under the care of hospice themselves – should not be frightened by medications used to relieve suffering. If a patient or family has any concerns, please reach out to the hospice team providing care.

Not only are hospices working to do the right thing for patients and families, but they are also working to ensure that the pain and suffering of dying Americans is properly addressed. And no professionals are better trained to do this than those working in hospice and palliative care.


Edo Banach
President and CEO