Laure Fuerstenberg promised her husband, Leo, that he wouldn’t die in pain. But when his organs started failing, his hospice care providers were nowhere to be found. The on-duty nurse had muted her phone and missed 16 of Laure’s calls.
“I called the hospice, and I said, ‘We’re in trouble. I need help right away.’” she recalled. “I waited and waited. They never called back.” Leo died that night.
Heartland Home Health Care and Hospice, the private-equity-owned hospice in Minnesota, never sent a nurse or doctor that day. It never sent painkillers to ease Leo’s suffering, either.
But it sure sent a bill.
“When they got paid for nothing,” Laure Fuerstenberg said, “it was like a slap in the face.”
As it turns out, not even hospice care is immune to private equity’s takeover of just about everything. One study found that the number of US hospices owned by private equity firms nearly quadrupled between 2011 and 2019. And the percentage of American hospices that operate for-profit in general has ballooned dramatically in the past couple of decades—going from approximately 40 percent of the total in 2001 to 72 percent in 2020.
Half of all Americans now die in hospice care—and a majority of them are now being treated by for-profit services. “Profit over people” is an unappealing MO for any company, but it is an especially ugly approach to operating a hospice, where the people in question are, by definition, some of society’s most vulnerable.
As Ava Kofman, a ProPublica reporter (and former Nation intern), writes in a powerful exposé, the for-profit acquisition of the hospice industry has been both swift and transformational. A national model that began with the goal of giving patients more control in their final days, and reducing the cost of unnecessary hospitalization, has become a lucrative enterprise over the past decade, coinciding with an overwhelming wave of private equity acquisitions.
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For-profit hospices deliver “substantially worse care experiences” than not-for-profit hospices, one study found. This is unsurprising, given the cost-cutting strategies at play: less staff is hired, often at lower skill levels; visits from nurses, social workers, and therapists are less frequent; fewer community benefits are provided; and medical treatment is outsourced to hospitals and emergency rooms at significantly higher rates—all at the expense of dying patients and their grieving families.
For those on Medicare—which most hospice patients are—care providers collect a flat daily rate, regardless of how much care they actually provide. This makes for an inefficient, and often fraudulent, business model. Some hospices seek out uneducated or low-income elderly people, fudging symptoms to justify terminal diagnoses, just to snatch $191 per day from Medicare. And some prioritize patients with illnesses that are less expensive to treat, like dementia, over more costly ones like cancer, to keep patients present—and therefore profitable—for longer periods of time.
And profitable it is. Medicare hospice spending in the US totals more than $22 billion per year. What’s more, for-profit hospices receive over 20 percent more revenue from Medicare than they actually spend on patients, often without any consequences. It’s not just a scam; it’s a taxpayer-funded scam.
But it doesn’t have to be. As the administrators of Medicare, the federal government has immense bargaining power in determining the quality of care hospice patients receive. When it comes to for-profit hospices, they could, very simply, stop paying the bill. Instead, Medicare could agree to reimburse nonprofit hospices only. After all, as Timothy Noah writes inThe New Republic, “This was never supposed to be an industry.”
What’s more, as the leading national associations of nonprofit hospices have demanded, federal action could be taken to regulate for-profit hospices, and protect their especially vulnerable patients. Such action could include limiting the number of new hospices and shutting down nonoperational ones so they don’t get sold off to private equity firms.
Dying peacefully in hospice, surrounded by our families, is the best ending any of us can hope for. We can’t sacrifice that most basic of dignities for the sake of enriching venture capitalists. The government can help keep hospice care a reliable, patient-first service—and ensure that any American with some time left can get quality end-of-life care.
Anyone who has had a loved one in hospice care, as I did with both my late husband and my father, will tell you that when it comes to making them comfortable in the waning days of their lives, there is no price you wouldn’t pay. But that doesn’t mean you should have to.
