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.