Non profit? for profit?

There is a blogpost with some interesting points and comments that I’d like you to read, The Danger of For-Profit Hospices.

The title alone gave me chills, did it do it to you too? I guess in some people’s minds, only those working in non-profits have the hospice heart, or give the best service and of course that is not true. It totally depends on the company.

Who owns the company is a good question and matters to a point. I’ve worked at 3 for-profit hospices and one nonprofit. One of the for-profits was owned by a large publicly traded corporation, one by a man who didn’t know hospice and owned other types of health care companies that all fed into each other, and the other by a man who owned a home health care company too. I could see the difference in focus in each of these 4 companies even though the people in each were committed to caring for the dying. Thankfully, only one of these companies fits the article’s description.

One issue the author wrote of was the issue of providing pull-ups instead of diapers. The non-profit I worked for pulled out the pull-ups two years before one of my for-profit employers did. I only know of one hospice that gives pull-ups anymore and not freely … lots of conditions to it and last I heard, they were phasing them out. I work in a nursing home now and have several hospices in the building. Tax status does not define the quality of care, the heart of the worker, or the supplies they bring. They are all basically doing the same thing.

It’s short sighted to make determinations of intention based simply on a company’s structure. How many physicians do you know in practice who are nonprofit? Do you still trust them? In my private practice as a consultant for families in crisis, there was only one hospice in town that took my most difficult, complicated, labor intensive cases and they were a for-profit agency. They were the only hospice who could handle these situations. So here is at least one example of a for-profit taking a financial hit to care for families.

Bottom line, I have colleagues I respect working in the various hospices in town. I’m proud to know all of them.

As a family what it boils down to is if you like the care you are receiving. If you don’t, see if changing one of the team members would handle it. If it really is the company, hire another. Ask some questions. Do they freely offer their home health aid services or do they say right off the bat 2 or 3 times a week? Ask how they respond to a crisis. Is their first option to go to the hospital, or is it a service we call continuous care? Continuous care is when the crisis is managed at home by the team. Do they have housekeeping services (which is not covered by Medicare), palliative physical/occupational therapy services, or pay for palliative radiation? Ask how medications are handled. Do you have to pick them up yourself or do they deliver?

Do they emphasize that it doesn’t matter which RN comes out, they are all good? May be true but it also may indicate a high turnover and/or that they manage visits by geographical efficiency each day, not by the continuity of nursing care. Most people in these vulnerable times prefer not to have a different nurse every week or every few days.

In just the short time I’ve been working in hospice (since 2000), I have seen operations change in both sectors drastically. Times are lean all around. Hospices must have strict business models to survive. Cold business and warm fuzzies will have to blend for a hospice to survive these days and provide the great hospice care people deserve. Time spent with a family used to not be so guarded. I long for those days, however they are basically gone. Read “The Hospice Blog,” by a physician who discusses the business side of hospice.

Please don’t be quick to judge a hospice based on their tax status. What makes a hospice great goes beyond that. It is also about who is knocking on your door. Both sectors get reimbursed by Medicare based on the geographic market and some other factors. Medicare doesn’t give for-profits more. Non-profits do a lot for the community and hands down win over the for-profits in that department. But don’t you think they should? They are the ones getting endowments, having fundraisers, receiving large donations, etc. They get all that extra money in addition to the Medicare reimbursement.

I’m blessed to know the many physicians, nurses, social workers, chaplains, home health aids, volunteers that I’ve met over the years. If they all worked at just the non-profit in town, the article makes sense. But they don’t. They work all over. I have my eye on the nurse I want caring for me when it’s my time and I don’t care at which hospice she will be when I get there.