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Hospice is all about care, not profit

by Doug Jena, Executive Director, Yolo Hospice

“Apparently the marketplace has joined hands with Death itself to defraud the taxpayer and cheat the truly terminally ill.” So wrote Thomas P. Lowry in response to a Washington Post December 18, 2011 article, “The big payoff of pushing patients into hospice.” This is just one of a rapidly accumulating number of studies and news articles investigating the explosive growth of for-profit hospices in the United States. Mr. Lowry’s response is understandable particularly when you consider the origins of the hospice movement as nonprofit agencies focusing on a mission vs. the current growth of for-profit hospices whose focus is, apparently, a business plan.

How did we get to this point?

The simple answer is that Medicare pays the majority of hospice bills with reimbursement for most hospice care. Hospice agencies then choose whether to invest their reimbursements into enriched patient services, or into shareholder pockets.

Consider this: Because of the intimate nature of hospice care and its delivery by compassionate clinicians whose work is more of a calling than a profession, hospice has established a spiritual sense of purpose and has long enjoyed admiration and respect from the communities it serves. Since the mid-70s hospices have endeavored to raise awareness about their compassionate services for those facing the end of life. And these nonprofit originators of the movement in the United States have been successful. But in 2005, for-profit hospices began to outnumber traditional, nonprofit hospices. The idea that for-profit hospices are now cashing in on this very rich tradition feels wrong to many of us.

It might surprise you that between 2001 and 2007, 99% of newly established hospices in the United States were for-profit. This is remarkable, but wouldn’t be of concern if everything else (like patient care) was equal. But it is not! Studies show that for-profit hospice patients received the full range of services only half the time that nonprofit hospice patients did. Additional studies conclude that for-profits “cherry pick” patients to minimize expense and maximize profit.

A recent experience at nonprofit Yolo Hospice illustrates the distinction between these two types of providers. Mary Jones (not real name) was a patient at Yolo Hospice whose condition actually improved while receiving hospice care. After discussion with Mary’s physician, family, and the hospice team, Mary was discharged from hospice services. Mary lived in a residential care facility and after a few years she moved to the skilled nursing part of that facility when her condition worsened. Mary was admitted to a different hospice at this point,  a for-profit hospice with which the skilled nursing facility had a relationship.

After a few weeks on service, Mary’s daughter had a chance encounter with Mary’s previous Yolo Hospice nursing case manager. The following story unfolded: The daughter lamented that Mary had been with the for-profit hospice agency for more than a month and still had yet to see a social worker. Further, the nursing case manager never reported back to the daughter on Mary’s condition. The daughter had to call the case manager to hear about the results of the seemingly too quick visits with Mary. By contrast, the Yolo Hospice case manager always called before her visits (to know what concerns to specifically address) and always reported back to the family for review and to address any of their concerns. Mary is now back on service with Yolo Hospice because she was advised that the choice of hospice providers was hers to make.    

It should be emphasized that neither nonprofit nor for-profit hospice workers are the villains here. Our Nation is built on the profit incentive. But…, profit in Hospice care? At what cost and at whose expense?

Today almost everyone has heard of hospice or they have been directly or indirectly served by hospice. But times are changing. The spiritually driven, community-based, nonprofit hospices of old are rapidly giving way to a for-profit industry of publicly traded companies.

At the end of life, at the sacred transition to the afterlife, a mindful presence and attention to physical, spiritual, and emotional needs are required to ease the transition with the full dignity it deserves. 

Ask yourself… If you or someone you loved needed a compassionate hospice provider, whose cultural or corporate guidance would you want for the agency delivering that care: Main Street or Wall Street?

You have a right to choose your hospice provider!

 

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