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Tuesday, August 11, 2020  

Not-for-profit and for-profit hospices:Is there really a difference?Published 8/25/2003

I’ve received a lot of questions lately about not-for-profit and for-profit hospices. What’s the difference? I hear this question not only from the general public, but also from other health care providers.

How is it that some hospices show a profit while others depend on public support? Don’t patients receive better care from a not-for-profit? Is there really a difference? My answer is yes and no.

From a financial standpoint, there really is no difference between the two not-for-profit hospices and nearly 30 for-profit hospices in our market. We all receive the same daily rate from Medicare.

The only financial differences are our tax status and the fact that not-for-profits have the opportunity to earn additional income through grants and funding sources such as United Way. Yes, that’s right. Not-for-profit hospices actually have the potential for more income than for-profits.

You may wonder why a hospice would want to file as a for-profit. And you may still be wondering about the question of quality of care.

As a professional who has worked in both the not-for-profit and for-profit sector, let me share a few reasons why I say yes, there are differences. These differences are found not just between not-for-profits and for-profits but are differences you’ll often find from hospice to hospice, regardless of tax status.

First, let’s go right to quality of care. Quality hospice care comes from a combination of experience, availability, and quantity of visits.

When choosing a hospice, ask if the hospice’s medical staff members are certified in hospice and palliative care. How many years of experience do their nurses have in caring for the terminally ill? Do their social workers hold masters of social work degrees? Do they use certified home health aides or nurses’ assistants?

Availability also greatly affects the quality of hospice care. When the referral is made, how quickly will the hospice send a nurse and social worker to visit? A quality hospice will respond within a few hours or at least, within 24 hours. When you call in the evening, on the weekend, or in the middle of the night, will you be able to speak to a hospice team member or will you speak to an on-call nurse who works for another agency? You should have access to a hospice team member 24 hours a day, seven days a week. If you need supplies or medication on the weekend, will the hospice deliver? A quality hospice will.

Even I’m surprised by how widely the number of visits varies among hospices. I’ve heard competitors who say their nurses visit patients once every other week. A quality hospice will provide a minimum of two nursing visits every week. They should be willing to increase nursing visits up to every day, if necessary to keep a patient comfortable and pain-free. Home health aide visits should be the same, and social work and chaplain visits should be as frequent as needed by the patient and family.

Another common misconception is that only not-for-profit hospices provide care for non-funded patients. This is absolutely not true.

All hospices should accept patients regardless of their ability to pay. I’m proud to say, that at Heartland Care Hospice, we cared for 20 non-funded patients last year. The value of care provided to these patients totaled $75,125.

Other areas where hospice services can vary are in volunteer and bereavement services. A quality hospice will invest both time and financial resources into recruiting and training volunteers. Volunteers provide companionship for patients and an additional helping hand for families. A strong hospice volunteer program will provide a volunteer companion for every patient or family who requests one.

Hospices provide bereavement services for family members and loved ones for 13 months after the death. Bereavement programs should include visits or calls by the chaplain, social worker, or volunteer as needed. They may also include memorial services, support groups, and reading materials. Many hospices extend their bereavement services to the community as well.

What about fundraising—don’t all hospices hold fundraisers? Many hospices hold fundraisers regardless of their tax status. For-profits obviously don’t have the opportunity to attract donors as non-profits do. At Heartland Care Hospice, we hold fundraising events to support our volunteers’ activities and to provide special services for patients. For example, we deliver a full Thanksgiving dinner to every home patient and his or her family in November. Every patient receives a visit and a gift from our own Santa Claus in December. Our fundraising events support these activities.

Coming from a not-for-profit background, I’m often asked how it is to now work in the for-profit sector. I say that I’m fortunate to work with a team who is dedicated to providing compassionate care for the terminally ill and is committed to improving the lives of the seniors in our community.

One of the benefits of being a for-profit hospice is that we can give back to our community. We realize that being a responsible community partner means give and take. Rather than continuously asking for community support, we look for ways to give back to those who have helped us.

In the last year, Heartland Care Hospice has donated money as well as staff time to projects such as the EMSMedFile program, the Alzheimer’s Association’s Memory Walk, the Edmond Senior Center Art Auction, and the Guthrie 89ers Day Parade. We also made the initial donation and led the fundraising efforts to pay for reconstructive eye surgery for a young cancer survivor.

These are just a few of the reasons I feel confident in telling others that I work for a for-profit hospice. Choosing the for-profit status isn’t about money. It’s about providing quality care for our hospice patients, their families, and our community.

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