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On a sunny Saturday morning in April, Barbara Rourke gazes toward the sea out her balcony windows. Her fourth-floor condominium on Ocean Boulevard in Pompano Beach offers a splendid view, although it's hard to tell whether she enjoys the seascape. She's a gray-haired wisp of a woman who spends her time either in bed or in a wheelchair; the latter has an attached tray table to keep her securely in place. Rourke moves her arms nervously at times, sometimes stroking her face and shoulders. The 68-year-old doesn't communicate by words anymore, though her eyes convey understanding and recognition at times. Doctors say Rourke is dying. She is in hospice care, which is end-of-life care intended to comfort rather than to cure.
Her husband died early last year after suffering a heart attack and then lingering on a life-support machine for eight months. Around the same time, she fell while walking on a sidewalk and was hospitalized for a possible broken hip. Since September, Rourke's daughter, Candess Rollins, and her husband, Joe Moran, have lived with her in the now-cluttered condo. Rollins quit her nursing job to care for her mother full-time. The living room furniture has all been shifted toward the balcony to make room for a U-shaped computer desk and file cabinets. The open space is just enough for a wheelchair to pass through.
"We have a visitor," Rollins says to her mother. Rourke studies the guest's face, then smiles warmly. "You look like one of her sons," Rollins explains to the New Times reporter. "We're going out on the balcony for a while," she says, leaving her mother with the weekend attendant, Doreen.
Rollins, whom everyone calls Candi, closes the sliding glass door behind her because Rourke is easily disturbed by conversations about her own health. Rollins isn't sure whether her mother understands the words or simply perceives the mood of the dialogue. Rollins is svelte. She sports shoulder-length blond hair and manicured nails. She's deeply tanned, and at age 36, her skin shows little damage from the Florida sun. The 42-year-old Moran is tall and bearded. His wife does most of the talking this morning, but he regularly chips in with exclamations of disbelief and revulsion.
The irony of it all, Rollins points out, is that the hospice intended to provide comfort and care for Rourke in her last days has, as with other families who have entrusted a loved one to Vitas Healthcare Inc., brought anguish instead.
Last September, a physician with the nursing home at which Rourke lived deemed her as "failing to thrive" and recommended a consultation with Vitas Healthcare. "They said Vitas was the hospice they worked with," Rollins recalls. "The social workers in the [nursing home] called it their hospice of choice, I guess."
A Vitas employee soon met with Rollins, Moran, Rourke, and a family friend. "We were sitting with my mother, and she was fairly alert," Rollins says. "The Vitas rep said, 'This is a very complicated case.' Then she asked, 'Does she eat?' We said, 'Yeah,' because we were, like, proud of that. She said, 'That's going to have to stop.' She was 70 pounds at that point."
Moran interjects, "I was freaking out. I said, 'You mean to tell me we're going to starve my mom to death? You're barking up the wrong tree. '"
Rollins says the rep explained that under Medicare guidelines, demonstrated weight loss is required to justify reimbursements to Vitas. "She said this in front of my mother," Rollins said, "and she was getting agitated."
Rollins and Moran felt confused about what to do, but they were certain they wanted their mother at home. Despite the bad start, they believed that Vitas could help them through the difficult time ahead.
What they didn't know then was that they'd signed on with Florida's only for-profit hospice, a company whose bottom line has at times led to hyperaggressive recruitment of patients. According to documents filed with the Securities and Exchange Commission, most of the company's revenues come from reimbursements by Medicare or Medicaid, the taxpayer-funded health-insurance programs for the elderly and poor. In the late 1990s, the Office of the Inspector General for the U.S. Department of Health and Human Services investigated those reimbursements for long-term cases and concluded that Vitas routinely enrolled patients who were not medically eligible -- in other words, they likely had more than six months to live. Since then, the company's demand for increased revenues has led to more pressure for referrals and enrollments, says one former employee, which has led to an overall decline in adequate care.
"They are not exaggerating in the least," Shelley Hines says of Rollins and Moran. Hines' 86-year-old grandmother, Dixie Moore, died in April after being referred to Vitas while at Plantation General Hospital. Moore had suffered a stroke and could not communicate, but she did continue to eat, Hines says. During the following six weeks, Vitas sent a procession of different aides who were there around the clock, but Hines complains: "The first day they came on, the feeding stopped. They just came and did nothing. There was no program. They didn't expect her to make it very long." Hines and other grandchildren kept feeding Moore baby food, until what was apparently another stroke ended her ability to swallow.