Profiteering: Patient-Centered vs. Profit-Driven Hospice Care – Part 4

RESEARCH FINDINGS ON PATIENT CARE QUALITY

Less Training for Hospice Care Providers

Other tactics for reducing expenditures at the for-profit hospices, according to the research, included hiring fewer professionally trained staff members, recruiting new graduates who would work for lower pay, and not offering on-site clinical training for hospice and palliative medicine physicians.^{23 24} Not-for-profit hospices were more likely to serve as training sites for hospice care providers than for-profit hospices, which has long-term implications for patient care.²⁵

The nation is currently facing a shortage of approximately 12,000 hospice and palliative medicine physicians, and just 180 fellows are graduating in this field annually – not enough to replace the number of retirees.²⁶ At just 31 percent of the total number of U.S. hospices, not-for-profit hospices cannot shoulder the burden of on-site clinical training alone,
given the need for an even larger hospice workforce in coming years.²⁷ 

Less Support of Research
to Improve Quality

As the hospice field grows, the need for research also expands – specifically to ensure ongoing quality improvement. Studies indicate that for-profits are less likely to conduct research for publication than not-for-profits,²⁸ and as with clinical training, this places a significant financial and coordination burden on the not-for-profits hospices to continually seek the best ways to provide end-of-life care.

Larger Numbers of Patient in Nursing Homes, Assisted Living Facilities

Home-based hospice care is typically more expensive to provide than care given in a nursing home or assisted living facility.²⁹ First, home-based care requires more travel time on the part of the hospice staff.³⁰ Second, the staff of the nursing home or assisted living facility often provide some of the primary support for a patient’s personal care needs, relieving the hospice provider of that kind of work.³¹ Research shows that, to maximize revenue, for-profit hospices tend to recruit patients in nursing homes and assisted living facilities and to provide less home-based care than the not-for-profit hospices.³² Once again, this puts the burden on the not-for-profits in the field to provide the more complex, expensive care, while also shouldering greater responsibility for staff and physician training and clinical research.