Profiting from the Dying

When my father was in the last year of his life, after a stroke rendered him unable to speak or eat solid food, my siblings and I made the difficult decision of enrolling him in hospice. Based on a friend’s experiences as a hospice volunteer more than two decades ago, I expected hospice workers who would spend time with him, comfort him and make sure he was never in pain.

But what I encountered were overworked and over-stressed staff. Although the hospice we hired had promised nurses coming every day, in reality they would come irregularly and stay a short amount of time, because they had many more patients to treat. We were promised spiritual counselors who never materialized. The social worker who seemed to genuinely care about my dad took me aside one day to tell me she was leaving the company because she was being asked to take on more clients than she could handle, and so was unable to give clients the care and compassion she thought they deserved.

It wasn’t always like this. When hospice was first started (by a British nurse in 1967), it was largely maintained by volunteers, people dedicated to comforting the dying. But a hospice system that was largely composed of caring volunteers changed when Medicare started paying for hospice care, and lot of businesses got stars in their eyes about how much money they could make off dying people. The result has been what you would expect: cost-cutting measures, mainly cutting back staff, to increase profits.

A New Yorker article, “How Hospice Became a For-Profit Hustle,”   provided some startling and horrifying statistics: While the hospice field was mainly non-profit at the beginning of the century, today for-profit providers comprise 70 percent of hospices. Between 2011 and 2019 the number of hospices owned by private-equity firms—companies whose main objective is to make money by buying a business, restructuring it and selling it at a profit– tripled. The article called the current hospice business “a twenty-two-billion-dollar juggernaut funded almost entirely by taxpayers” through Medicare.  

“Companies in the hospice business can expect some of the biggest returns for the least amount of effort of any sector in American health care,” the New Yorker reported. And those buying and owning hospices are not necessarily in the medical or care industries but include accountants or vacation-rental owners. Small hospices can collect more than a million dollars a year while large hospices can bring in hundreds of millions. Because government regulators rarely verify claims for payment, there is little accountability.

Not only does this for-profit mentality hurt those who are dying, because they are not getting the care they need, it also hurts the dying person’s family and friends, especially the over-burdened caregivers who enlisted the support of hospice.  But it also affects the hospice workers, who presumably entered this field because of a deep commitment to aid people in their dying days. Their commitment is being callously exploited by their bosses, who are wringing as much work out of the hospice staff as they can in order to cut costs and raise profits.

Similarly, many senior-care facilities are being bought by profit-making companies, which cut the number of staff, lower the quality of the food and decrease the amenities (such as exercise classes) that were once offered.

That we allow businesses to make money off the most vulnerable people in this society and at the most vulnerable times of their life is reprehensible.  At the very least, private-equity firms should not be allowed to own hospices; at the very most, no company should be allowed to make money off the dying.

14 thoughts on “Profiting from the Dying

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  1. I think it’s ok for a business to make money off of any morally acceptalbe activity, including hospice. But, some kind of feedback and rating system should be in place to provide people with information to make an informed decision on which business to select. I’m thinking of something like the charitable organization rating system.


    1. The whole situation with senior-care facilities and hospice is not good for those of us who will likely need their services. One additional problem is a shortage of staff.


  2. You describe the experience I had with hospice when Jeeg was dying. Everything I had heard and read about hospice made me believe that they were there so that I could spend more quality time with my loved one. I bought into this illusion, which made a horrific experience even worse. It took Jeeg 6 weeks to die at home with hospice “care,” most of which was sporadic visits to take her vitals and then spend twice that amount of time filling out forms on a hand-held device. The best thing I can say about them was first that the hospice workers were always kind and caring–with Jeeg and with me–and they made sure she had the pain meds she needed, even though I sometimes had to pester them for more. She was bathed only once–though she was promised a twice-weekly bath–because the second time the healthy aid showed up to bathe her, she was wearing scented hand lotion that wafted into the house as soon as I opened the door to her. I sent her away and bathed Jeeg myself.

    Thank you for writing about this, Kath. The trauma of that experience with hospice has compounded my grief in a way I don’t think I will ever get over. I sincerely sympathize with the nurses who take on this task out of love but have to work for companies that are no more than machines with calculators.


    1. Thanks, Verna, for sharing your story. It makes me very sad that you had to go through that. Experiencing Jeeg’s dying was hard enough without extra irritation/pain from hospice.

      Liked by 1 person

  3. Yes, it’s a deplorable situation. It’s important to look for a hospice that is nonprofit and always ask friends who have experience with choosing a hospice for their recommendations.


  4. It is indeed revolting and scary, when you think of what is in store for you as you get older and more dependent.


  5. Kathy, there are some accrediting agencies for Senior Housing, most importantly CARF ( which credentials addiction and substance abuse facilities, retirement living, and services for persons with disabilities. We found our CCRC community this way, searching for non-profit facilities in selected states. Later we discovered that our community fostered the CARF process and standards 50 years ago. We also have had great success with non-profit hospice care for my mother, and in our community. Locating the good ones requires diligence and research.

    Liked by 1 person

    1. Thanks, Betty, for the info about CARF. It’s good that you were able to find a good CCRC community. And I’ve been told, also, to look for non-profit hospices. But they seem to be few and far between. In my community, I believe there is only one non-profit hospice. I agree that diligence is necessary.

      Liked by 1 person

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