Corporate Hospice: The Evil Empires

On this blog I’ve alluded to my disdain for large corporate hospice, but have not gone into why I’m not a fan of these companies and the way they do business. Time for that to change.

I’ve actually been thinking about this subject because I’m gathering my thoughts for a large series of posts on how to choose a hospice. At this point that series will span seven or eight different posts, but many of them will deal with this subject in some small way. Knowing that, I figured I’d start the process of getting my opinions and experiences from my head and into a form that non-hospice types could digest and understand by explaining the difference between those hospices that I term “the evil empires” and the rest of us.

First, let me explain what I mean when I say a large hospice company. My easiest example is Heartland Hospice, which is a division of HCR Manor Care (NYSE: HCR) and boasts almost 60,000 employees. Now before Heartland/HCR Manor Care sicks their fleet of attorneys on me, I am not saying in any way that they abuse, hurt, or even give poor care to their patients. I would guess that many of those 60,000 employees are awesome at their jobs, and some of their offices give great care to their patients. I do not call these companies evil empires because they treat people poorly; I believe they are evil empires, because they, in general, suck the heart out of hospice care.

The key to understanding my thoughts on this subject is understanding that the difference in good care and great care is in the pennies not dollars. Here’s my ultimate example. I know for a fact that one of the large corporate hospices refuses to provide pull-up diapers for its patients who need diapers. It makes no difference what the situation is, if you wear adult diapers you must wear the kind that someone else puts on you. To me that is a huge dignity issue. If you are incontinent but can still pull up your pants, then you are going to want to keep your dignity. The difference between you being able to dress yourself or you having to ask your spouse or children to change your diaper is $.23. That’s right; my supplier charges me twenty-three cents more per pull-up than regular adult-diapers. I’m sure the difference is even smaller for the huge companies that buy in greater bulk than I do. Will I ever try to save the quarter and force someone to forfeit their dignity one day earlier than they must? No! But at least one company has made it a policy.

That’s an easy decision for me because I’ve met every patient and every family on our service. I’m not about to do something like that to my patients or their families. It’s a no brain decision. Sure I may never be able to afford 50 yard line seats or the nicest room on the cruise ship, but that’s the sacrifice I’m willing to make to do right by my patients. The decision is easy when the buck stops in your office. That decision is hard when you are answering to your stockholders. If the huge hospice has 3,000 people in pull-ups per day they could save up to $500,000 a year by forcing them to switch to traditional diapers. When you start talking about that much money and the person making the decision hasn’t met face to face with a patient or a family in years, then the decision is much harder. Diapers are only one example, but one that I thought the blogosphere may understand.

The baseline of this argument is that some major care decisions are made by the people who control the money. With that in mind, I would never trust a company where the financial people have no access to the patients. It is easy to make financial decisions that hurt patient care when you don’t actually understand what a patient looks like. That is why I’m against huge corporate hospice. In the most general way, the easier access you have to the owner of the company the better care you are going to get. I know that is not always true because there are some greedy small hospice owners, but if you are going to paint with a big brush, that’s where I’d draw the first line.