KANSAS CITY, Mo. - Last year alone more than 1.5 million people in the United States needed hospice care, but when it comes to choosing which facility someone you love spends their final moments in, how do you know you're choosing the right one?
A FOX 4 investigation found out you can't count on the state of Missouri to ensure your loved ones are safe in their most vulnerable moments.
For more than 53 years, Stella Kartsonis' husband, Ernie, made her laugh.
"We had a good time with one another," said Kartsonis.
The laughter didn't stop even during Ernie's long-term battle with atypical Parkinson's, the disease that eventually killed him.
Through many of those years, Stella took care of Ernie on her own, until it got to be too much.
"There came a day when I felt overwhelmed," she said. "I got in my car and drove right over there and walked in the door and said I think I need to talk to somebody, I think I need help."
Stella talked to friends who recommended Kansas City Hospice and Palliative Care.
Others may consider online resources, like the inspection reports listed by the state of Missouri.
A 1992 statute requires the state to survey hospice facilities once a year, but FOX 4 found one third of hospice care centers in our area haven't been surveyed in at least six years.
In the past year, the state has only surveyed three of out 27 in our metro area. Hospice facility directors say they've been told there's not enough money for regular surveys.
"Several years - this has been the case, but it has been getting more acute I would say in the past four or five years," said Elaine McIntosh, President and CEO of Kansas City Hospice and Palliative Care.
She explained the lapse in surveys concerns her.
"It does. I am a believer in having outside entities come in and evaluate an organization, even the best organizations can make mistakes."
Kansas City Hospice and Palliative Care is one facility that hasn't been surveyed in five years. Elaine McIntosh says she welcomes state inspectors.
"I think that not being surveyed can cause an organization to become a little lax about maintaining certain standards," McIntosh explained.
The Missouri Department of Health and Senior Services says "Inspections are done at hospices when possible."
The whole state of Missouri has only 10 inspectors who also handle surveys of outpatient physical therapy and home health facilities, among other programs.
"I think the problem is what else is the state missing out on? And how many other people may be being harmed and we don't know about it?" Republican Missouri State Representative Noel Torpey said.
After FOX 4 reported our findings, Rep. Torpey said he's already called fellow lawmakers to let them know hospice facilities aren't getting the attention the law requires.
"This is a very important priority," he explained. "I think the first plan is to ask them why the state statute isn't being enforced, and if they say funding, then why haven't you asked for funding?
Stella agrees the state needs to step up and check on hospice facilities.
"Maybe it behooves the public to get a little more knowledgeable about the things that need to be done and need to be inspected and taken care of, and we ought to ring a bell," she said.
She hates to think someone else won't get the quality care her beloved Ernie got, preserving the memories of the happy, vibrant, dignified life he led for 82 years.
"Never be afraid to ask questions because it's your loved one. You're the one that cares the most about them," Kartsonis said.
Just because the state hasn't inspected hospice facilities on a regular basis, doesn't mean there's a problem. In fact in our research- Fox 4 found very few verified complaints.
In Kansas, federal rules govern the 86-hospice facilities. In Kansas state workers act as contractors for the Federal government. Those rules require inspections every seven years.
Next April that changes, when the Federal Impact Act takes effect, it will require hospices in Kansas to have inspections every three years. Rep. Torpey says he may push for Missouri to also follow those federal guidelines.