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hospice care from new york times article

Adapted from Gavid McGruddy on Unsplash.

Paula Span, the New York Times writer on all things aging, just published a piece on profit vs non-profit hospice. 

“Nearly three-quarters of hospice organizations are now for-profit,” she says. Yet (no surprise here) nonprofit hospices do a better job on several measures, including expelling patients who are taking too long to die.

If you’re not familiar with the term “hospice,” the NIA says:

“Hospice care focuses on the care, comfort, and quality of life of a person with a serious illness who is approaching the end of life.” It’s designed for situations when a serious illness can’t be cured or a patient chooses to forego treatment. A move to hospice puts an end to attempts to cure the underlying illness.

Former President Jimmy Carter chose to enter hospice care rather than receive more treatment for an undisclosed illness. He’s reported to be in good spirits, according to this NBC News report

In contrast, according to the NIA, “palliative care is specialized medical care for people living with a serious illness, such as cancer or heart failure.” It includes symptom relief as well as treatments attempting to cure the underlying illness.

Hospice has become an increasingly popular option for end-of-life care. As Paula Span reports:

“Roughly half of Americans who die each year now turn to hospice. The number of Medicare beneficiaries enrolling in hospice rose to 1.7 million in 2020 from 580,000 in 2001.

The increase in demand has attracted for-profit players.

When compared, the non-profits …

…fulfilled requests for special supplies and equipment much faster
…were less likely to discharge patients before they die (breaking the “implicit contract” to care for their patients through the end of life)
…weren’t involved in fraud cases  (such as billing

More than a third of nonprofits, but only 22 percent of for-profits, were “high performers,” says the article. That’s still a low number: almost two-thirds of the nonprofits were *not* high performers, as were nearly 80% of the for-profits.

The article concludes, “Most family caregivers still give hospice care high approval ratings.” The Times article provides no data to support this claim.

There appears to be a scary parallel with nursing homes,

The CDC reports 15,000 nursing homes in the US, about 70% for-profit, with a total number of licensed beds of 1.7 million (as of 2018).

The CDC reports elsewhere 4,700 hospice care agencies, 1.6 million patients (as of 2018), and 66.4% for-profit.

The parallels are not encouraging. In my book on aging stereotypes, I cite statistics on abuse in nursing homes. It’s hard to believe there’s no abuse in hospice. Moving people back and forth between hospital and hospice would seem to come close.

We need to stop being squeamish about the end-of-life process and look to ways of dying with dignity. That may include, for many people, an option to choose medically-aided dying.

The Times article referred to the need for reform. They’ve published many articles about abuse in nursing homes, even identifying the problem as a crisis and Something’s Got to Give.  There’s no evidence that anything has changed there and it’s likely even less will change in the hospice arena.