I’ve gotten a couple of interesting e-mails in response to “Corporate Hospice: Evil Empires” from hospice workers around the nation telling of their experiences working for the Evil Empires and then switching to different hospices that actually care for their patients. One e-mail was from a nurse who switched from an Evil Empire to a non-profit hospice and says that the switch made all the difference.
I’ve been waiting as long as I could to enter into the debate between profit and non-profit hospice, because I know I’m going to anger many of the people that are solidly on my side when it comes to fighting for improving hospice care throughout the country. The time has come. Buckle your seatbelts, get ready to send hate mail, and prepare to lose all respect for me. Ready?
I do not believe that non-profit hospices give better care, are more ethical, or are more compassionate, than for-profit hospices. Wow, it feels good to get that off my chest! I know a few “bigwigs” for non-profit hospices and must say that their snobbish attitude toward profit hospices amazes me. I’m not sure why having IRS 501(c)(3) status makes you better than anyone else, and would greatly appreciate it if those who are non-profit would get their noses out of the air long enough to figure out that the enemy is not for profit hospices. The enemy is any hospice that does not give good care.
When I think about starting my own hospice the profit/non-profit question is not a hard one. Let me try to explain the facts as I see them:
- It doesn't take a rocket scientist to break even in this business, thus there is little need for outside fundraising.
- If my company is for-profit I'll make a decent salary, and could even take home a little profit every once in a while.
- If my company is non-profit, I'll make a decent salary.
- If my company is for-profit, when the time comes to retire I can sell the company for a few hundred thousand dollars.
- If my company is non-profit, when the time comes to retire I'll get a gold watch.
That sums up the time I spent on that question. I have a passion for taking care of people with a terminal illness, but if I can swing a decent retirement while taking good care of people, what’s wrong with that? We don’t treat doctors like lepers because they make a decent living from caring for people. So why hold hospices to a different standard?
I know my e-mail box is going to be full of information about the things that some non-profit hospices do that are above and beyond what a typical hospice does, and I concede that point. You can’t run a summer grief camp for children who have lost a parent without raising some outside money. You can’t do “make a wish” type stuff for your patients without raising some outside money. I’m well aware that some non-profit hospices go far above and beyond the call of duty, and that is great. I think it’s wonderful, but the key here is that those things are above and beyond. Many profit hospices have non-profit divisions that do those things. (Heartland Hospice, which was my one named example of an Evil Empire, has the HCR Manor Care Foundation: Hospice Memorial Fund which is designed to do those above and beyond type things.)
This post has gone on much longer than I intended, so I’ll wrap it up here by saying that I know of many non-profit hospices that spend their money much worse than profit hospices do. Most for profit hospices have crappy little offices where three people have to share one desk. Many non-profit hospices have castles. I’ve never heard of a profit hospice sending their staff members on an all expense paid vacation, but some non-profit hospices do that type of stuff quite a bit. Just because a company spends all their money each year to keep their non-profit status, doesn’t mean they spend it well.
Many who have entered the fight to ensure quality patient care have drawn a line in the sand between profit and non-profit hospices. Those people are fighting the wrong battle. Patient care, patient care, patient care. That is the banner we must take up! There are unethical for-profit hospices and there are unethical non-profit hospices. I’m for exposing all of them, and ensuring that all hospices take care of their patients. Who’s with me?!?
4 comments:
I agree wholeheartedly, and believe that your observations extend to ANY healthcare provider. I've worked for for-profit and not-for-profit. There are inadequacies and waste in both types of businesses yet patient care can always be up front IF the powers that be make it a priority and foster that mission with their employees. Sadly, many do not.....the bottom line is the buck.
I am currently struggling with this issue myself. I have worked the past three years at a not-for-profit hospice. This organization has really been struggling to mainatain their "castle". They have admitted to staff that they are using donated money, intended for patient care, to pay staff salaries. I strongly diagree with that. Recently, I was terminated from that organization, johnny on the spot, with no verbal warning, counseling, or any other "write-ups". We have a new for-profit organization in our community that I am interviewing with. I have said in the past that I would NEVER work for a for-profit hospice. The CEO of my former employer has stated many times, "We're not in the business of making money from dying patients." A phrase I fell for hook, line and sinker. Thank you for your insight on this controversial topic. It will influence my decision of whether or not to work for a for-profit organization.
As a fundraiser for a non-profit hospice, I'm sure my commentary could be chalked up to my arguing for my job security, but I feel what I have to share is very relevant. I don't have prior experience fundraising for a hospice, so I've had to learn a lot about what we do. Your comment about it not being hard to break even in this business is absolutely correct. However, I find it challenging to believe that you've actually read the guidelines for medicare and medicaid reimbursement. If you had, you'd know that essential community bereavement services are not "paid for" by direct patient care reimbursements. Though we are required to maintain a substantial volunteer program (administration costs of upwards of $75,000 annually), we are never reimbursed for those costs. We aren't reimbursed for providing one on one or group grief counseling for teh patients and families who've lost someone on hospice with us and we definitely aren't reimbursed for the camp we put on over the summer that addresses the needs of children who've recently lost a loved one, often their own parent. Not one of these services are profit-driven. Therefore, they're of little to no interest to for-profit hospices, unless they are required to keep their doors open. Food for thought from someone who's actually in the field right now.
I just wanted to say a bit about the above comment. I agree, that some hospices use their fundraising efforts for things that are far above and beyond what hospices are required to do. In the comment, there was a bit of confussion on what hospices are required to provide and what many hospices provide.
I'm a big fan of hospices that provide counseling to the community as a whole and grief camps for kids, but hospices are only required to provide grief support for the families of their patients and nothing more. Many hospices do nothing more.
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