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Posts Tagged ‘not for profit’

http://www.npr.org/sections/health-shots/2017/08/11/542607941/nearly-1-in-5-hospice-patients-discharged-while-still-alive

When I first saw the headline for this NPR story, I thought it was a good news story! One in five patients being discharged from hospice! That’s amazing!

But when I dug into the article, I realized how wrong I was. You see, in the US, most hospice operate on a for-profit basis. They are looking for ways to improve the bottom line by moving out patients who might need costly medical procedures – re-admitting them after they’ve been treated. As well, there’s evidence to suggest that they may be over-admitting patients who might not be within 6 months of death, thereby insuring that they fill all their beds. This doesn’t sound like good news to me!

Hospices in the United States began much like those in Canada – through the pioneering efforts of people following the example of Dame Cicely Saunders, founder of St. Christopher’s Hospice in London.  Once Medicare began to pay for the “hospice benefit,” for-profit enterprises (including venture capitalists) began purchasing and establishing hospices. The result of this is described in the attached article.

We are not perfect here in Canada – hospices are not adequately funded by Medicare and millions of dollars must be raised by each not-for-profit hospice just to survive. Costs are kept down by the use of thousands upon thousands of volunteers – providing enormous savings in staff salaries and invaluable services of all kind. As many people have noted, volunteers are the heart and soul of hospice and the benefits we provide are immeasurable.

Volunteers are essential to American hospices as well, of course. In fact, to receive funding through the hospice benefit program, at least 5% of staffing costs must be provided by volunteers. That’s a huge incentive to organizations to attract and retain volunteers.

Not all hospices in the U.S. operate on a for-profit basis. And I’m sure that some of the for-profit hospices provide excellent, caring services for people at the end of their lives. Nonetheless, I’m glad that in Canada, so far, we’ve maintained the non-profit basis for hospice services established by the founders of the hospice palliative care movement.

 

 

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In my last post, I intimated that I’d be writing about for-profit and non-profit hospices, since for-profit hospices are now growing at an astounding rate in the US since Medicare and private insurance companies extended coverage to include hospice benefits. The differences between the US and Canadian health care systems are vast and I’m not going to tackle explaining them (or trying to understand them fully!) here. In simplest terms, Canada provides publicly funded, universally accessible health care to all its citizens and permanent residents. The US does not. Of course we all know that there are many gaps in our health care system, and universal accessibility is one of the big gaps that we face.

In terms of hospice care, both Canada and the US can trace the origins of hospice care back to Dame Cicely Saunders, who founded St. Christopher’s House in 1967, the first modern hospice. Early hospice care in the US and Canada was much more of a movement than any sort of business, driven by nurses, volunteers, and physicians. In Canada, Dr. Balfour Mount of Montreal stands at the forefront, having coined the term palliative care, and established palliative and hospice care services at the Royal Vic in Montreal and in the surrounding community. Florence Wald is credited with a similar role in the US.

Over the years, however, the ground has shifted considerably in the US. With Medicare funding now available, there’s a lot of money to be made in hospice care.

The following article from the Washington Post, part of a longer series, reports on an in-depth study of some of the similarities and major differences between non-profit and for-profit hospices in the US. I won’t attempt to summarize it here, as the info-graphic and the text speak volumes. Check it out if you’re interested!

http://www.washingtonpost.com/business/economy/2014/12/26/a7d90438-692f-11e4-b053-65cea7903f2e_story.html

More to come from Virginia where it is supposed to be 70 degrees today. Hard to stay inside my studio and write!

 

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