Hospice Patients Alliance: Consumer Advocacy


Whether or not the hospice you use is a "for-profit" corporation or a "nonprofit" corporation should not make a difference in the quality of care you receive, but it sometimes does. The regulations are exactly the same. All licensed and certified hospices must comply with State law and the Code of Federal Regulations governing hospice care: 42 CFR part 418. However, it must be noted that there are some large for-profit corporations which are either buying up hospices all over the United States or forcing the smaller hospices out of business by using questionable marketing practices which are sometimes outright illegal. In any field of business there are the "good" and the "bad," and hospice is no different. There are ethical nonprofit corporations and ethical for profit corporations, while there are unethical nonprofit or for profit hospice corporations. Picking the wrong hospice can have disastrous results in terms of your loved one's care.

For-profit corporations are organized for the purpose of making money and paying dividends to their stockholders. Nonprofit corporations are supposed to be organized for the purpose of fulfilling the nonprofit mission of the corporation. Although it would seem that nonprofit hospices would naturally provide better care than for-profit hospices, some nonprofit (as well as for-profit) hospices have been found guilty of health care fraud, and have not provided proper hospice care. The best indicator of whether or not you should choose one hospice or another is the direct personal reference from someone you know who has had recent experience with the hospice services.

It is not realistic to assume that all for-profit hospices provide less care than nonprofit corporations. But because hospices are paid on a per-diem basis for every day the patient is enrolled in the program, any hospice which "skimps" on services can increase its profits at the expense of the patients and families. Any hospice which you use could provide excellent services. You will need to be knowledgeable about the services which you are entitled to receive, be assertive in advocating for the needs of your loved one and your family, and be involved in the decision making which occurs.

Some hospices (nonprofit as well as for-profit) have constructed inpatient hospice facilities of their own. These facilities cost a lot to operate and must have patients to fill the beds and cover overhead of the hospice. Because of the hospice's overhead, some hospices routinely manipulate patients into their own facilities, even when the patient wishes to remain at home to die. By keeping the beds full, the hospices can charge room and board fees to increase their profit margins or decrease their losses. Do not let any hospice "railroad" you into its facilities when it is against your wishes. You have the right to make your own decisions whether to have your loved one stay at home till the end or transfer to a facility. Whether "for-profit" or "nonprofit," the hospice is required to provide the care that meets your needs related to the terminal illness.

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