Profit-driven Hospices Offer Lower Standards of Care Compared to Non-Profit Institutions
In a groundbreaking investigation, a new study published in JAMA Internal Medicine has found that patients receiving care from for-profit hospices have substantially worse care experiences than those treated by not-for-profit hospices. The study, conducted by the RAND Corporation, assessed various domains, including help for pain and other symptoms, and getting timely care.
The study's lead author, Rebecca Anhang Price, is a senior policy researcher at RAND. She emphasized that not all for-profit hospices provide poor quality, and families and health care professionals can look at quality metrics available for hospices in their area on Medicare's Care Compare website.
The research team calculated scores across eight quality measures: hospice team communication, timely care, help for symptoms, respectful treatment, emotional and spiritual support, getting training to care for the hospice patient at home, overall rating of hospice care, and willingness to recommend the hospice to others.
Across all eight quality measures, a substantially higher proportion of for-profit hospices were in the low-performing category as compared to not-for-profit hospices. This trend was further reflected in the finding that those who received care from for-profit chains reported the worst care experiences. Family members of patients treated by for-profit hospices were nearly 5 percentage points less likely to definitely recommend their hospice to others.
Since 2000, the number of for-profit hospices has more than quintupled, and the proportion of hospices that are for-profit increased from 30% to 73%. This growth has raised concerns about the quality of care provided by for-profit hospices.
The study included all types of hospice settings, such as home-based care, hospice inpatient care, and hospice care provided in a nursing home. Prior research has shown that for-profit hospices provide care differently than not-for-profit hospices, such as employing fewer and less skilled staff.
However, it's important to note that the quality of care varied, with some for-profit hospices performing better than the national average. The RAND Corporation study identified several hospice chains with the poorest patient care experiences, but it did not publicly name specific chains involved.
The study evaluated responses from over 650,000 Consumer Assessment of Healthcare Providers and Systems Hospice Survey questionnaires completed between Q2 2017 and Q1 2019, before the Covid pandemic. Support for the study was provided by the Centers for Medicare & Medicaid Services.
RAND Health Care promotes healthier societies by improving healthcare systems in the US and other countries. Other authors of the study are Layla Parast of the University of Texas, Austin, Marc N. Elliott, Anagha A. Tolpadi, Melissa A. Bradley, Danielle Schlang, and Joan M. Teno, all of RAND.
As more and more people turn to hospice care in their final days, it's crucial to ensure that the quality of care remains a top priority. This study serves as a call to action for policymakers, healthcare providers, and the public to scrutinize the profit motives in hospice care and work towards improving the overall quality of care for dying patients and their families.
