Hospice Care and the Opioid Crisis

The incidence of opioid overdoses has quadrupled since 1999, and in 2015, opioids were involved in more than 33,000 deaths nationwide, according to the U.S. Centers for Disease Control and Prevention (CDC).

Until recently, hospices have been largely left out of the national discussion on opioid abuse, as patients receiving hospice care often need—and are prescribed—higher doses for pain management.

However, a 2017 Kaiser Health News report discussed the growing issue of opioid abuse within the industry. According to the article, caregivers, relatives and neighbors of hospice patients have been found to steal—and abuse—the opioid painkillers meant for their loved ones.

Industry Response

The epidemic has incited industry associations to develop and promote guidelines for hospice agencies. Included in this group is the Virginia Association for Hospices and Palliative Care (VAHPC), which released its “Risk Evaluation & Mitigation Took-Kit,” to provide strategies for responsibly managing the safe use of opioids. The National Hospice and Palliative Care Organization (NHPCO) also issued a compliance guide on the Medicare Hospice Conditions of Participation (CoPs) for the management and use of drugs.

Meticulous Monitoring

Among other recommendations, these guidelines provide steps (also outlined in the Medicare CoPs) that hospices should take to safely manage and dispose of controlled drugs at the time they are ordered for the patient. These include:

• Providing a copy of the hospice written policies and procedures on the management and disposal of controlled drugs to the patient or patient representative and family.
• Discussing the hospice policies and procedures for managing the safe use and disposal of controlled drugs with the patient or patient representative and the family in a language and manner they understand to ensure that these parties are educated regarding the safe use and disposal of controlled drugs.
• Documenting in the patient’s clinical record that the written policies and procedures for managing controlled drugs was provided and discussed.
• Hospices that provide care in their own facility must dispose of controlled drugs according to the hospice policy and state and federal requirements, as well as maintain records of the receipt and disposal of all controlled drugs.

What happens to opioids after a patient’s death depends on what state you operate in—the U.S. Drug Enforcement Administration forbids staff from destroying the drugs, specifying “a member of the hospice patient’s household may dispose of the patient’s pharmaceutical controlled substances, but the home hospice or homecare provider cannot do so unless otherwise authorized by law (for example, under state law) to dispose of the decedent’s personal property.”

This is an issue for hospice providers trying to combat the problem and, according to Kaiser Health News, several states have taken action and passed laws that allow hospice staff to dispose of the drugs following a patient’s death.

As more state and local associations develop and implement guidelines to combat the opioid crisis, it’s important to be aware of your agency’s medication management protocols, and what staff are lawfully allowed to do.

The Role of Your EMR Provider

EMR software can provide valuable help in managing medications. Find out what type of support your EMR provider offers for medications, particularly scheduled narcotics and integration with a hospice-dedicated PBM to ensure improved access, documentation and compliance around opioid use

To learn more about the opioid crises and other trends impacting hospices, download the Top Six Trends Impacting Hospice Care in 2018.