Profit vs Not for Profit

osiris7 · Nov 21, 2004

I work for a non-profit, and I can tell you---I've heard stories from patients as to why they left the for-profit agencies. They were told they couldn't continue chemo or radiation ("call us when you're done with that") , they felt pressured to have a DNR, they didn't have a dedicated hospice inpatient facillity. These are just some of the things I've heard.

You are absolutely correct in terms of billing and funding---we work exactly the same way, except that actually the non-profits have a sort of built-in advantage because they often receive a lot of charity and benefactor money. I think that this fact alone often allows them to be more lenient: They often have deeper pockets.

webblarsk · Nov 21, 2004

I work for a non-profit, and I can tell you---I've heard stories from patients as to why they left the for-profit agencies. They were told they couldn't continue chemo or radiation ("call us when you're done with that") , they felt pressured to have a DNR, they didn't have a dedicated hospice inpatient facillity. These are just some of the things I've heard.
You are absolutely correct in terms of billing and funding---we work exactly the same way, except that actually the non-profits have a sort of built-in advantage because they often receive a lot of charity and benefactor money. I think that this fact alone often allows them to be more lenient: They often have deeper pockets.

Well I guess every place is different but the agency I work for has never turned anyone away or not let them continue a palliative treatment. I live in a small rural community so we don't have inpatient hospice facilities. But we have a contract with the local hospital, local pharmacies and dme companies. We provided whatever our patient needs regardless of the cost. And its just really frustrating to be put down because of the word "for profit". We give excellent care and our first priority is the patient and the family, not the money.

renerian, BSN, RN · Nov 22, 2004

If I personnaly every bashed your company I am sorry. I have been brash only as I did consult with one and found some big issues related to money/payments/fees and mostly the donational fund.

I have seen one company actually kept the donations as profit/not intended for that. The hospice hubby works for/yes non profit/I volunteer there has the following services:

nursing

therapy

dietary

chaplin

social services

home health aides

volunteers

massage therapist

pet therapist

aromatherapist

music therapist

respite workers

bereavement for up to 3 years

I may have missed other services. I have seen other hospices/from the inside so it is not hearsay.. refer their bereavement care to other hospices as they did not want to spend the money to have a person with that specialty-now that is cheap/stinkey. Yes it does meet the intent of the standard by referring them somewhere but most hospices have their own programs. Definately cheap.

I have heard/yes firsthand-a for profit hospice say that if a patient dies in a nursing home they don't need a death call as the staff of the facility can do that care-that is not the point. The point is to provide excellent care not turf work off. I have also heard that same hospice won't allow volunteers for the patient if they are in a facility???Why? I have no clue.

I have other examples of abuses by SOME for profit hospices.

Now being the devils advocate, hubby and I go round and round almost monthly if not more about this topic. I alway say...there has to be good for profit hospice companies out there somewhere.

It sounds like your part of a wonderful organization and are very happy. I am happy for you.

renerian

chris_at_lucas_RN, RN · Nov 22, 2004

I've heard stories from patients as to why they left the for-profit agencies. They were told they couldn't continue chemo or radiation ("call us when you're done with that") , they felt pressured to have a DNR, they didn't have a dedicated hospice inpatient facillity. These are just some of the things I've heard.

I've never heard of a requirement for a hospice to have an inpatient facility, in fact, my understanding (and I could be wrong) was that ideally hospice was home care, at home.

As for the chemo or radiation, again, maybe I'm wrong, but in order to be eligible for hospice, don't you have to be terminally ill, expected not to survive six months, and no longer eligible or a candidate for anything but palliative care?

Sometimes we get a little focused on the honor of being a nonprofit (mind you, not for profits can earn a profit....). There is no dishonor in making a profit! If we are paid well we can continue to provide good service. A too-tight budget often reduces morale as much as pressure to keep up production, and even saints get burned out.

OP, I'm glad you could vent.

renerian, BSN, RN · Nov 22, 2004

I too am glad for the vent and there is no requirement for an inpatient unit. Low moral can be very bad for any entity especially health care related places. I am glad someone posted a good hospice. I kept telling huby I know there are some/somewhere. I guess it is like any other health care services. Check out what each one has to offer and go with the best fit.

renerian

webblarsk · Nov 22, 2004

Thank you all for being kind and having kind words. I know that there are probably shady hospices out there but there are also very good hospices out there about doing the right thing, regardless if they are "for profit" or "not for profit". I love my job but just get frustrated hearing "oh you are for profit" Thanks again for listening and being so supportive..

webblarsk · Nov 22, 2004

If I personnaly every bashed your company I am sorry. I have been brash only as I did consult with one and found some big issues related to money/payments/fees and mostly the donational fund.
I have seen one company actually kept the donations as profit/not intended for that. The hospice hubby works for/yes non profit/I volunteer there has the following services:
nursing
therapy
dietary
chaplin
social services
home health aides
volunteers
massage therapist
pet therapist
aromatherapist
music therapist
respite workers
bereavement for up to 3 years
I may have missed other services. I have seen other hospices/from the inside so it is not hearsay.. refer their bereavement care to other hospices as they did not want to spend the money to have a person with that specialty-now that is cheap/stinkey. Yes it does meet the intent of the standard by referring them somewhere but most hospices have their own programs. Definately cheap.
I have heard/yes firsthand-a for profit hospice say that if a patient dies in a nursing home they don't need a death call as the staff of the facility can do that care-that is not the point. The point is to provide excellent care not turf work off. I have also heard that same hospice won't allow volunteers for the patient if they are in a facility???Why? I have no clue.
I have other examples of abuses by SOME for profit hospices.
Now being the devils advocate, hubby and I go round and round almost monthly if not more about this topic. I alway say...there has to be good for profit hospice companies out there somewhere.
It sounds like your part of a wonderful organization and are very happy. I am happy for you.
renerian

Our organization is wonderful. We have a "faith fund" set up for memorial donations. We have several ideas of things to use this for to benefit our patients and family. We have also had numerous patients that could not pay and that were taken anyways. We did not take the money from the "faith fund" but instead just absorbed the cost. These patients recieved excellent service and did not get the short end or less care. We also have several patients in nursing homes that our Volunteers see on a regular basis and our personal policy is that a nurse attends every death. Nursing home or not. I feel very strongly that no patient or family member should be alone. I actually just let a nurse go last week for not going out to a patients home after they passed away. Its a shame that there are hospices out there that are not doing the right thing. It makes me sad and angry.

renerian, BSN, RN · Nov 22, 2004

I know there are hospice's just like other health care entities that are doing things to bring light and scrutiny to the hospice benefit. It will be changing and I hope it shakes out okay. Hubby has a fear it will not.

Thanks for posting good things about for profit hospices.

renerian

aimeee, BSN, RN · Nov 23, 2004

Its great to hear that you work for a for-profit hospice which really has its priorities in the right place. Each institution should be judged on its own merits. Unfortunately, when you look at overall actual statistics, for-profits on average provide fewer services.

Ownership status and patterns of care in hospice: results from the National Home and Hospice Care Survey.
Carlson MD, Gallo WT, Bradley EH.
Department of Epidemiology and Public Health, Yale School of Medicine, New Haven, Connecticut, USA.
BACKGROUND: The number of for-profit hospices increased nearly 4-fold over the past decade, more than 6 times the growth of nonprofit hospices. Despite this growth, the impact of ownership on hospice care is largely unknown. We sought to assess differences in the provision of services to patients of for-profit and nonprofit hospices. METHODS: Using the 1998 National Home and Hospice Care Survey, we examined services used by patients (N = 2080) cared for by 422 hospices nationwide. We used multivariable ordered logistic and logistic regression to assess the effect of profit status on service use, adjusting for potentially confounding patient and organizational characteristics. We calculated point estimates adjusted for sampling weights and standard errors adjusted for the clustering of patients within hospices. RESULTS: In ordered logistic models controlling for organizational and patient factors, patients of for-profit hospices received a significantly narrower range of services (adjusted odds ratio [OR], 0.45; 95% confidence interval [CI], 0.22-0.92) than patients of nonprofit hospices. This result is driven by patients of for-profit hospices receiving significantly fewer types of hospice services that federal regulations term "noncore" or more discretionary services (adjusted OR, 0.34; 95% CI, 0.15-0.75). CONCLUSION: The pattern of care differs in for-profit and nonprofit hospices. As the industry develops a substantial for-profit presence, it is critical for clinicians and other healthcare professionals to be alert to the potential impact of profit status on the care their patients receive.

If you think about this, it really makes sense. If non-profits have more "income" than outflow, in general they take that money and use it to expand their services because their whole reason for existence is to serve the dying. For-profits must have profit for their shareholders or their stock will be sold and the company will decline in value. That doesn't make them "evil". Its just, well, business.

Regarding the issue of providing palliative chemotherapy or radiation, again, I doubt this is a matter of lack of beneficence. Its a matter of financial survival. Hospices with a small census can often barely cover the costs of even basic services under the medicare per diem reimbursement. Larger hospices, with a greater financial base and often a larger donation pool, are in a better position to provide more expensive drugs and treatments where warranted. They might also have a homecare division and a palliative program in place so that persons who are still seeking such treatments can pursue them while receiving the help and support that are so necessary when facing end of life issues.

webblarsk · Nov 23, 2004

I am so glad to know I am working for a company that wants to do the right thing. It really bums me out that there is companies that are giving the good companies bad names. We are a small company but like I have said before our patients recieve whatever they need and we don't worry about the cost. We have social service, chaplain service, volunteer services, bereavement for 13 months, SN visits, HHA visits, dietician, physical therapist, speech therapist. Our HHA's see our patients 3-5 times a week to provide personal care. SN's visit 3-5 times a week. Nursing home patients are seen just as often and recieve the same care as those in the home. We go out for all deaths and have been known to spend hours with a dying patient and their family. I think I said earlier that we are a new Hospice in a Rural community but have had 60 patients in 8 months and have received nothing but praise. Alot of the cases I have seen here are CHF, Dementia, COPD patients. I have had some cancer patients but the need for palliative chemotherapy or radiation has not been an issue yet. I do currently have a patient with cancer of the larynx that I arranged a consult for trach placement for ease in breathing. The patient saw the surgeon and unfortunatley the surgeon said at this point the surgery would not help. But because the patient asked about the surgery I made the appointment. The day that I believe that the company is no longer intrested in the well being of the patient and family is the day I will no longer work for this company. I hope I am making some sense............I'm just really frustrated that day after day we are doing the right thing and still hear so much negative. Thanks again for letting me vent and being supportive..........

webblarsk · Nov 23, 2004

massage therapist
pet therapist
aromatherapist
music therapist
respite workers
renerian

I am very intrested in the services listed above, could you tell me more about them. I would love to get some or all of those things implemented. Thanks so much.:)