The Cost of Compassion

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Since the mid-70s hospices have been trying to spread the word about their compassionate services for those facing the end of life. And they have been successful. Today almost everyone has heard of hospice if not been directly or indirectly served by hospice. But times are changing. The spiritually driven, community-based, not-for-profit hospices of old are rapidly giving way to a for-profit industry of publicly traded companies.

In 2005, for-profit hospices began to outnumber traditional, not-for-profit hospices that were the community-focused and largely volunteer founders of the concept in America.

Because of the intimate nature of hospice care and its delivery by compassionate clinicians who think of their work more as a calling than a profession, hospice has established a spiritual sense of purpose and has long enjoyed a high level of admiration and respect from the communities it serves. The idea that for-profit hospices are now cashing in on this very rich history and tradition feels wrong.

It might surprise you that between 2001 and 2007, 99% of new hospices created in the Untied States were for-profit. This is remarkable in itself but wouldn't be of such concern if everything else (like patient care) was equal. But it's not! An accumulating body of research is cataloguing the difference. Studies have shown that for-profit hospice patients received the full range of hospice services only half the time that not-for-profit hospice patients did. Additional studies conclude that for-profits "cherry pick" patients to minimize expense and maximize profit.

Let me emphasize that neither non-profit nor for-profit hospice workers are the villain here. Our nation is built on the profit incentive. But  profit in hospice care? At what cost and at whose expense?


At the end of life, at the sacred transition to the afterlife, a mindful presence and attention to physical, spiritual, and emotional needs is required to ease the transition with the full dignity that it deserves. 

Let me ask. If you or someone you loved needed a compassionate hospice provider, whose cultural/corporate guidance would you want for the agency delivering that care: Main Street or Wall Street?
With a Perspective, I'm Doug Jena.