Patients spending the end of their lives in for-profit hospices receive substantially worse care than those who are in nonprofit hospices, a new study claims.
To come to that conclusion, RAND Corp. researchers analyzed surveys completed by people whose loved ones had spent time in more than 3,100 hospices throughout the country.
The research included reviewing more than 650,000 surveys completed prior to the pandemic, between the second quarter of 2017 and the first quarter of 2019.
“Our results are not explained by the geographic regions the hospices operate in, or by the types of patients they care for,” said study lead author Rebecca Anhang Price, a senior policy researcher at RAND. “These findings are particularly pressing given the striking growth of for-profit hospices, which have profit incentives that have been shown to affect how they care for patients.”
The study included all types of hospice settings, from home-based care to hospice inpatient care to hospice care provided in a nursing home.
Family members reported worse care experiences, on average, from for-profit hospices across all the domains they assessed, including help for pain and other symptoms and getting timely care.
The family caregivers of patients treated in for-profit hospices were nearly 5 percentage points less likely to definitely recommend their hospice to others, compared to those in nonprofit hospices.
A substantially higher proportion of for-profit hospices were in the low-performing category for all eight measures compared to nonprofit hospices. Those who received care from for-profit chains reported the worst care experiences, according to researchers.
Still, quality of care varied widely: Some for-profit hospices performed above than the national average.
“Not all for-profit hospices provide poor quality,” Anhang Price said in a RAND news release. “When choosing a hospice, families and health care professionals can look at the quality metrics available for hospices in their area on Medicare's Care Compare website.”
Hospice care focuses on improving the quality of life of a dying person and their family. People are eligible for hospice care if they are expected to live six months or less.
About half of Medicare recipients who died in 2020 received hospice services, compared to fewer than one-fourth in 2000.
While it began as a mostly volunteer community-based service, for-profit hospices have more than quintupled in number since 2000. Private equity firms are increasingly buying them. About 30% of hospices were for-profit in 2000, compared to 73% in 2020.
RAND noted prior research that found for-profit hospices provide care in ways different from nonprofit hospices, including employing fewer and less-skilled staff.
The study used responses to the Consumer Assessment of Healthcare Providers and Systems Hospice Survey, a questionnaire that is completed by a hospice patient's primary family caregiver after the patient has died.
The findings were published Feb. 27 in the journal JAMA Internal Medicine. Support for the study was provided by the U.S. Centers for Medicare & Medicaid Services.
The U.S. National Institutes of Health has more on hospice care.
SOURCE: RAND Corp., news release, Feb. 27, 2023