The bad news is that, in their quest for Medicare dollars, for-profit hospices don’t provide all the care that they should in order to fulfill the hospice mission of maximizing patients’ quality of life. In fact, a 2004 Medical Care study of 2,080 patients enrolled in 422 hospices across the country found that “terminally ill patients who receive end-of-life care from for-profit hospice providers receive a full range of services only half the time compared with patients treated by nonprofit hospice organizations.” That’s because for-profit hospices like to keep costs low by skimping on services, particularly so-called “non-core” services like medications and personal care (How these are classified as “non-core” services I don’t know—they seem pretty important to me—but there you go). For example, families of patients receiving care from a for-profit hospice received counseling services, including bereavement counseling, only [45% as often] as those in a nonprofit hospice. Translation: when researchers controlled for differences across patients, sicknesses, and conditions, those at for-profit hospices were only half as likely to get the same support provided at nonprofit hospices. A 2005 follow-up study confirmed that for-profit patients receive a “narrower range of services” than nonprofit patients.
This is an issue I have strong personal feelings about, having worked for a very large for profit hospice and a medium sized community non-profit hospice. I'm always hesitant to say that for profit hospices don't provide good care; I know there are many that do. I also know there are many non-profit agencies that provide sub-standard care. In my own experience, however, the non-profit hospice I now work for provides many more services than the for profit I used to work for. We have a large number of volunteers that provide massage and reiki therapy in addition to standard volunteer services. We have a volunteer run Transitions program for people who aren't quite ready for hospice or don't yet qualify for it. We provide more supplies, such as pull-up diapers and food supplements, than the for profit did.
Full Disclosure: This is only a comparison of two hospices that I have personally worked for and not reflective of the entire hospice industry
The entire atmosphere is different as well. At the for profit I worked for, the focus seemed to be to bring in as many patients as possible - unless they were going to die in the next 24 hours or needed expensive care such as tracheotomy care and feeding tubes. Patient care decisions seemed to center around cost management. At the non-profit I work for now, patients are brought in because they need hospice care. Period. Patient care decisions are centered around what is best for the patient.
This isn't to say that the hospice I work for now isn't concerned with the bottom dollar. Every hospice has to budget carefully, especially in this time of impending cuts to the Medicare reimbursement plan. It is, however, admirable to run a hospice agency with financial finesse and excellent patient care - whether your for profit or non-profit.
I've recently written an article about choosing a hospice provider with a focus on who own the hospice.
I'm sure there are some strong opinions on this topic and I'd love to hear what you have to say. Leave your comments below!