Palliative & Hospice Care Expert Overview

Forensic casework involving hospice and palliative care will often require some clarification on the bounds and overlapping nature of these medical specialties. This article provides legal professionals with a high-level explanation of palliative vs. hospice care and touches on some of the issues that are commonly addressed in expert witness investigations.

Palliative & Hospice Care Expert Witness Investigations

What is the Difference Between Palliative and Hospice Care?

Palliative care is the medical specialty focused on improving the quality of life of people facing serious illness. Emphasis is placed on pain and symptom management, communication, and coordinated care. Palliative care is appropriate from the time of diagnosis and can be provided alongside curative treatment.             

Who can benefit from Palliative Care?

  • Patients with chronic diseases that are worsening.
    (congestive heart failure, dementia, or COPD)
  • Patients who receive a devastating diagnosis
    (Stage 4 cancer diagnosis, massive CVA) 

Hospice provides support and care for persons in the last phases of an incurable disease so that they may live as fully and comfortably as possible.

Hospice recognizes that the dying process is a part of the normal process of living and focuses on enhancing the quality of remaining life. Hospice affirms life, and neither hastens nor postpones death.

To qualify for hospice care under most insurance programs, a physician must certify that a patient has less than six months to live if the disease follows a usual progression. (Subsequent certification periods are required at certain milestones to ensure the patient continues to meet hospice requirements.)

Features of Hospice Care

  1. It falls under the umbrella of palliative care.
  2. It is an insurance benefit.
  3. It provides specialized services for terminally ill patients (defined as <6 months life expectancy).
  4. Patients have the choice of living at home or in a facility.
  5. Curative treatment has stopped; the focus is strictly on quality of life and symptom management.
  6. A patient can voluntarily revoke hospice care at any time if it no longer meets their goals or the diagnosis has changed.

Most Prevalent Hospice Diagnoses

  • Dementia (non-Alzheimer’s type) – 14%
  • CHF/Cardiac Disease – 14% (EF <20%, NYHA Class IV)
  • COPD/Non-infectious Respiratory Disease – 9% (O2 dependent, FEV1 30% or less)
  • Stroke – 6%

Palliative and Hospice Care Expert Diagram

Expert Witness Investigations Involving Palliative & Hospice Care

Three common issues that arise in palliative and hospice care investigations are medication management, recertification falsification, and patient falls; though there are many others not captured in this article.

Medication Management

End-of-life medication management is intricate and complex. Hospice patients are often on many medications for end-of-life complications such as moderate to severe pain, difficulty breathing, anxiety, constipation, nausea, increased secretions, and hallucinations.

Most common medication errors involve:

  • Taking The Wrong Medication
  • Receiving The Wrong Dosage
  • Omitting Dosage
  • Wrong Route of Drug Administration
  • Wrong Patient
  • Look-Alike Drugs

The combination of many medications, including narcotics, requires specific staff training to ensure they are equipped with the necessary skills and knowledge to provide quality care to patients.

Communication between interdisciplinary staff (i.e., physicians, pharmacists, nurses, social workers, and chaplains) and family caring for these patients is critical to ensure patient safety.

Recertification Falsification

The Centers for Medicare and Medicaid Services (CMS) oversees compliance with the Medicare health and safety standards for laboratories and all providers and suppliers, including hospices, hospitals, nursing homes, and home health agencies.

Hospice care must meet criteria set by CMS for proper payment and recertification of each patient at set periods. These recertification evaluations, also called “face-to-face encounters,” can be performed by hospice physicians or hospice nurse practitioners.


As terminal patients become weaker, the risk of falls becomes greater. A rigorous fall prevention plan is a critical priority in hospice and palliative care settings. Having appropriate assessment, prevention, and intervention tools in place can assist in complying with national standards and keeping patients safe.

When investigating a hospice patient fall incident, an expert review may include items such as staffing and scheduling records, training policies and documentation, and the organization/facility’s communication protocols.

Hospice & Palliative Care Expert Witness Investigations

The experts at Robson Forensic are qualified to investigate various issues relevant to palliative and hospice care, including medication incidents, falls, recertifications, and advance directive challenges.

For more information, submit an inquiry or call us at 800.813.6736.

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Rebekah Price, Doctor of Nursing Practice & Health Care Expert

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