(This post is part of a series of posts. To read from the begining of the series go here.)
As I said in the previous post, the differences between hospice companies are often small and usually hard to find. This post deals with one thing that I feel is a huge difference; Ownership.
Who owns the hospice is a very important question, because it gets to the very core of the reason the company exists. If a company is listed on the stock exchange, then the stockholders are the owners. Do you think they invested in the company because they wanted to own the stock of a company that takes good care of people? Do you think Charles Schwab advises their clients to invest in HCR Manor Care (the owner of the national chain Heartland Hospice) because they treat people right? No, investors buy stock because the company makes money. If the owners of the company are focused on profit, then those that run the company must make money or else. Do you think the CEO of Heartland Hospice or, the largest hospice in the nation, VITAS (owned by Chemed who also owns Roto-Rooter) is more likely to lose his job because of poor patient care or poor earnings? In that situation, patient care can not be the number one priority. Your priority is your loved one; if that isn’t their priority, then there could be problems. Avoid the problem by finding out who the owner is and what their background is. Some of this information can be found on the company’s website if you want to do that research to avoid wasting time with a phone call.
Many hospices are non-profit, so they may say something like, “We are owned by our community”. The community won’t be expecting profits from the company, so your free to move to the next question. I’m not saying that non-profits are always your best choice, but they do avoid the ownership profit-margin issues that can come with some for-profit hospices.
A follow-up question here would be to find out what else the company owns. Two years ago, I would have told you that a hospice that does anything other than hospice is a warning sign that you may not be working with the best. Now, many hospices are diversifying into other areas of healthcare because of instability within the hospice industry. They are branching out to solidify their bottom line just in case the government makes changes to the Medicare Hospice Benefit that negatively effect hospices financially. I guess that means that my advice here is to find out what they did first. If they do home health and hospice, odds are they did home health before they did hospice. This means that hospice isn’t their core business or mission, they branched out to hospice for the same reasons hospices are branching out to other health care businesses today. The problem in this type of situation is that these companies generally will view hospice as the equivalent of home health and treat hospice the same way they treat their home health. You want a hospice that exists to do hospice. It is crucial that your hospice see hospice care as something sacred. They will all tell you that they do, but knowing their ownership background will help you know which ones to believe. A hospice that has branched out into other areas of health care may be just fine, but companies that branched out into hospice may be a red flag.
That’s question number one. I’ll post on question number two in another post.
A special note for those of you choosing a hospice for someone in a nursing home:
Do not use a hospice that is owned by your nursing home. Let me repeat. Do not use a hospice that is owned by your nursing home. Odds are the nursing home has told you that you should consider hospice and in the same breath told you that you should consider a specific hospice. If the hospice they recommend is owned by the nursing home or by the same person/company who owns the nursing home, stay away! I can not stress this enough. The biggest service a hospice provides for nursing home residents is a different set of eyes and ears for the patient. A hospice that is not affiliated with your nursing home will not have any problem reporting a problem if they see one. Their focus is making sure that the patient is cared for, and if they have to point out poor care that is being given by the nursing home, then so be it. If the hospice and nursing home are in bed together, then the hospice employee knows that they are making their boss look bad when talking to families about issues related to the nursing home. Worse than that, many nursing home/hospice combo companies have some crossover employees. If the nursing home nurse changes her nametag during the day and becomes the hospice nurse, do you really think she will do much in the way of assessing the patient? She saw the patient earlier in the day as his/her nursing home nurse, so why pay attention later just because she has a different name tag on? One more time: do not use a hospice that has the same owner as the nursing home. Every nursing home patient needs someone who is willing to rock the boat. Hospice workers are often professional boat rockers; don’t reduce the impact that hospice can have on your loved one by using a hospice that can’t speak freely when there is a problem.
For the sake of clarity here, I am not saying that hospices that are owned by nursing home companies are not good at what they do. Some of them may be excellent, but there is an inherent conflict that comes from them caring for patients in their own facilities.