Megan Steiner has worked as a nurse in nursing homes around Detroit for almost 20 years. She is able to distinguish between non-profit and for-profit hospice organizations caring for dying patients. Steiner has observed that non-profit hospices have more frequent visits from nurses, pastors, social workers, and other staff. They also respond quickly to requests for supplies and equipment. On the other hand, she noted that for-profit hospices take days to respond to requests and are quicker to discharge patients.
Steiner is now working as a private nurse and certified death doula in Hamburg, Michigan. She has noticed that non-profits are more aggressive in maintaining patient registrations, while for-profits are “ostensibly taking patients away because they no longer met their standards.” The longer enrollment and immediate discharge could increase hospice profits and help avoid fines.
Overall, studies show significant differences between for-profit and non-profit hospices. In 2001, non-profits provided care for terminally ill Americans who were expected to die within six months, while commercial hospices were still emerging. Now, nearly three-quarters of the country’s more than 5,000 hospices are for-profit.
However, there are concerns that for-profits care more about profits and less about the patients. Critics argue that non-profit hospices provide better care since they have higher daily spending per patient and can provide more personnel. For-profit organizations have a higher likelihood of discharging patients before their deaths, leading to distress for the family. A recent report by MedPAC showed that for-profit organizations received 20.5 percent more from Medicare than they spent on providing services.
To combat fraud and improve services, experts suggest strengthening how Medicare conducts quality surveys and moving from a prorated payment model to more individualized reimbursement. Families seeking hospice care for their loved ones need to be cautious and do their research while taking into account factors such as quality ratings.
Despite the growth of commercial hospices, hospice care remains an important part of the healthcare system. Even with changes and challenges, family caregivers continue to rely on hospice care and understand its importance.