A Lesser Known Effect Of the Opioid Crisis: Painkillers Being Stolen From Dying Hospice Patients
Hospices and homes that take care of the elderly often have copious amounts pain-killing medication on hand. Family members, staff, and others who are close to the patients often have access to this medication for dispensing to the patient.
However, sometimes the patient doesn’t get it. Sometimes it walks right out the door.
I used to work in an adult foster care home, and indeed, I saw this happen. In this case, that patient had already passed, and unfortunately, there was a big bottle of morphine unaccounted for. Tapes revealed the owner’s daughter was the person who took it.
Because older people often need these drugs due to end-of-life pain, the recent crackdown on opioids in the U.S. has largely overlooked hospice care. But some say that hospices and other caregivers aren’t doing enough to ensure the patient is getting the medication, and it’s not being diverted by a family member or other staff.
Now, in the midst of the opioid epidemic, many states are passing laws that give hospice staff members the right to dispose of or destroy unused medication after hospice patients pass. But often, hospice patients are cared for in their own home or a family’s member home, a setting that is very hard to monitor.
Behold the following cases:
A nurse discovered a hospice man at his home crying, holding his stomach, and complaining of unbearable pain. The man was dying of cancer, and his neighbors were stealing his painkillers every day.
Parents kept losing medication, such as a bottle of methadone, for their child who was at home dying of brain cancer. Of course, the medicine wasn’t misplaced at all.
A hospice woman at home started vomiting for anxiety over an intense family conflict. Her daughter was stealing her medication, and her son was physically fighting her off. He begged the hospice to put his mom in a nursing home.
And then there are those cases of hospice staff or employed caretakers who often work in the home unmonitored, and steal patient’s medication.
For example, last June a former hospice nurse from New Mexico plead guilty of drug diversion. She would recommend prescriptions for hospice patients who didn’t really need them and then intercept the packages to sell the drug herself.
Hospice And Diversion
Hospice is a very fast growing industry that services over 1.6 million patients each year. It is available to those who are expected to pass within six months and is seeing increased enrollment as people live longer and want to be comfortable and around loved ones during the last moments of their life.
Medicare covers much of hospice’s services, such as nurses, aides, hospital beds, oxygen, and medication. However, there is a lack of national data on how often medication comes up missing – but some experts believe it is extremely common. I worked in a small home with very few staff, and yet, I saw it happen myself.
In Missouri this year, government investigators placed a hidden camera in the home of a 95-year-old patient to probe a case of suspected theft. As a result, an aide was charged with stealing hydrocodone tablets, opiates, and substituting acetaminophen in its place.
Also, in recent years, nurses in Massachusetts and Louisiana have also been charged with taking medication from the homes of patients.
But often, thefts don’t get reported, much less get conveniently caught on camera.
Monitoring Hospice Medication
Recent research (see references) posits that hospice physicians and social workers nationwide are ill-prepared to evaluate patients and families for drug abuse or to handle the issue of painkiller theft.
Hospices are required by Medicare to ensure that the medication is safely administered to patients and identify a competent caregiver or staff member to manage the drugs.
It also requires hospices to enact policies and speak to the families about the safe and secure manage and disposal of medications. However, oversight is often minimal, and years can pass between hospice inspections.
And in many states, hospices don’t even have much control over the medication after a patient passes.
While the Drug Enforcement Administration encourages hospice personnel to assist families in the destruction of unused medication, technically those drugs belong to the family, and they have no legal reason to forfeit them.
But recently, states such as Delaware, New Jersey, Ohio, and South Carolina have enacted laws granting authority to hospice staff to dispose of leftover medication when patients pass. Other states are considering similar legislation.
~ G. Nathalee Serrels, M.A., Psychology