Hospice Is Now a $17 Billion Business

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Hospice has provided end-of-life care in the U.S. since 1974. While volunteers were paramount in the early days of hospice, it has now evolved into a $17 billion industry, dominated by for-profit corporations.

Fran Smith, author of “Changing the Way We Die,” a book about hospice care, discussed the rapid growth in hospice and the cultural changes the program has experienced with Marketplace.org. Smith said:

[Hospice] started off 40 years ago in this country … as a grass-roots cause, all nonprofit. And increasingly it’s a for-profit venture. More than half of Hospice programs are run by for-profit companies, more and more big, publicly traded chains.

Statistics from the National Hospice and Palliative Care Organization confirm Smith’s assertion.

The number of for-profit Medicare-certified hospice providers has been steadily increasing over the past several years. In contrast, the number of Medicare-certified not-for-profit or government providers has begun to decline over the same period.

Smith describes hospice as the most successful segment of the health care industry. About 44 percent of the 2.5 million people who die in the U.S. each year do so in hospice care.

So big bucks are up for grabs, which is likely why so many for-profit businesses are getting in on the action. One such company is Chemed Corp., which owns Roto-Rooter and Vitas – the largest hospice chain in the country.

Smith said hospice is a business venture that’s paying off.

They’re making a lot of money. And there’s a lot of concern about the way for-profits are making money. There’s pretty good research evidence that shows that for-profits tend to cherry-pick the most profitable patients, which tend to be patients with dementia, Alzheimer’s, patients who will stay on hospice care a long time.

The Medicare Payment Advisory Commission or MedPAC said patients at for-profit hospices do in fact experience longer stays – an average of 102 days, compared with 69 days at nonprofit hospices.

Moneymaking aside, hospice allows patients to die in comfort at home or another familiar location. It’s that comfort that keeps hospice a popular choice for end-of-life care, Smith said:

People don’t want to die in hospitals, don’t want to die in intensive care units. And for people who want to die at home in comfort, hospice is the best way to go.

Were you surprised to learn that many hospices are owned by for-profit corporations?

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  • mona

    Die in comfort at home ?? I beg to differ. We went through hospice
    hell with my father dying at home under the “care” of a for-profit
    hospice company. We were ignorant and naive and my father suffered for
    it. First off they gave us a little booklet containing a basic drug
    list and some diagrams, and then it’s congratulations, you are now a
    practical nurse, go take care of your father. The RN will call you once
    a week. How does an untrained layperson assess the patient, turn,
    lift, feed, clean, administer meds without hurting the patient? You
    don’t. After many phone calls and threats they finally supplied nurses
    but said there was no guarantee whether a nurse would come next shift,
    in which case we were on our own. The quality of nurse varied widely
    depending on the individual and what agency they came from. The ONLY
    pain med was morphine tablets. When he became unable to swallow pills,
    the tablets were crushed into water and put between the cheek and gums.
    Which were not well-absorbed at all. No injections, no IV’s of pain
    meds available. No other pain meds that would have worked better than
    morphine. He cried out in pain numerous times when the nurses were
    having to move him.

    Until they provided some nurses, the burden
    of care was on us two daughters and it was a 24/7 job, totally
    exhausting, no sleep, no time for personal hygiene, no time to run
    errands such as buy food and other necessities. The nurses relieved
    this somewhat but it was still so stressful we were unable to sleep
    much. Don’t think you are going to do this and still go to work every
    day. Don’t choose home hospice unless there are SEVERAL people who can
    trade off providing care. Ask about the pain med protocol. We found
    out too late some other hospices did do injections, although apparently
    no home hospices do IV pain meds. I am firmly convinced morphine-only
    and not providing nurses until we threatened to sue them was pure profit
    motive – providing nurses or more expensive meds than generic morphine
    cuts into their profits.

    After what we and my father went
    through, I sincerely hope I can die in a hospital or one of the rare
    in-patient non-profit hospices. Probably not possible though, hospitals
    will force you out as soon as you are labeled terminal because from
    that point, on they don’t get reimbursed for providing you care. That
    happened to my mother, but fortunately she went into non-profit
    in-patient Houston Hospice, where her last few days were peaceful and
    pain-free. Total 180 from what my father went through in home hospice.

  • NoCellPhones

    Yep, we too used a for-profit hospice for my husband. I did a ton of the care myself, but they did come and were supportive when needed. They weren’t bad, but their support was hit-n-miss and they had little understanding of how stressed I was as this went on for 16 months. I don’t think they liked me. I was never told I could get Depends or “Chucks” from the hospice so I bought those myself. Once my husband died, they dropped me like a burning coal. I was given no after-care or directed to after-care. I felt abandoned and lost for months. I heard later about the care provided by non-profit hospices that sounded MUCH better.

  • Lorilu

    Beware your insurance, too. When one of our parents died in a non-profit hospice, which was a wonderful, caring, place, the insurance company refused to pay most of the bill. Though this hospice only accepted people who were deemed to be very terminally ill, the major health insurer in our state refused to pay about two-thirds of the stay at hospice, claiming the patient was not “sick enough.” This though the patient had seizures, could not walk, was on oxygen, in extreme pain, etc. The family ended up paying for three months of a five-month stay, and the insurance company blew us off.