The Curse of Hospice

I have a love/hate relationship with Hospice.

Hospice takes care of people when medical professionals believe they are at the end of their lives. A nurse or doctor will evaluate someone and if they meet certain criteria, they are put on Hospice.

People at Hospice companies are generally wonderful, compassionate, caring people. Unfortunately however, they must follow the Medicare rules and not provide care that is meant to cure people. Only make them ‘comfortable’ as they are dying.

Even if someone in my assisted living homes needs to go to the hospital for some sudden issue, we have to disenroll them in the Hospice program to be treated. The hospital (hopefully) will try to improve their health condition.

And improving someone’s health goes against the Hospice rules.

For someone like me who believes we should fight for good health every day of our lives no matter how sick, it’s hard to take.

My employees in many cases feel the same way. And they have a great track record. We all work to improve people’s health enough that they ‘graduate’ from Hospice. Their health improves to the point where they no longer qualify for Hospice.

Eventually all of us will be on Hospice, and will not graduate. Even our people who graduate eventually go back on Hospice. We should all want to delay it as long as possible though.

In our work to help people graduate, we’ve had a lot of success. We had one gentleman move in to one of our homes in 2016 on Hospice.

Not only did he graduate from Hospice. He passed away in August, 2024. He lived another 8 years.

That’s 8 years he was able to spend with his family. 8 years where he was able to see his grandkids grow into adults.

We have had so many people ‘graduate’ from Hospice, that one Hospice social worker told one of my managers:

She was joking. At least that’s what we told ourselves. It did make me think what perverse incentives Hospice has.

Another problem with Hospice is their rigid rules. Medicare regularly audits Hospice companies to make sure they are in compliance. They are very careful to make sure one of our residents truly meets the criteria before they go ‘on service’.

Once they are in Hospice, the company makes sure not to prescribe any medications or therapies that might improve the patient’s health.

Besides the obvious ethical problems with those rules, it seems like there is no room for innovation. One of the reasons I try to make my assisted living residents so much healthier is to differentiate my business from my competition.

All those rigid rules means every Hospice company has to do everything the same way. The way they win business from their competition is to just become really good friends with the healthcare businesses and ask their ‘friends’ to help them out. They can’t try out anything that might improve the Hospice industry overall.

I wish we could have a new paradigm for the Hospice industry.