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Invited Commentary |

The Changing Face of the Hospice Industry:  What Really Matters?

Kimberly S. Johnson, MD, MHS1,2,3,4
[+] Author Affiliations
1Division of Geriatrics, Department of Medicine, Duke University, Durham, North Carolina
2Center for the Study of Aging and Human Development, Duke University, Durham, North Carolina
3Center for Palliative Care, Duke University, Durham, North Carolina
4Geriatrics Research Education and Clinical Center, Veterans Affairs Medical Center, Durham, North Carolina
JAMA Intern Med. 2014;174(4):507-508. doi:10.1001/jamainternmed.2013.13304.
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In recent years, the tremendous growth in the number of for-profit hospices has received increasing scrutiny in both the lay press and medical journals. Academicians, reporters, and government regulators have raised concerns about for-profit hospices’ aggressive marketing practices, narrower scope of services offered, and enrollment of a case mix of patients with longer lengths of stay and higher profits.14 Although there is no direct evidence that the quality of care provided to patients differs by hospice ownership,5 some believe that for-profit hospices, unlike nonprofit hospices that led the movement to improve the care of the terminally ill, are more often motivated by making money rather than by the altruistic goal of providing quality care to dying patients.

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hospice

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Hospice may not be Optimal for Frail Elders
Posted on February 26, 2014
Joanne Lynn
Center for Elder Care and Advanced Illness
Conflict of Interest: None Declared
Dr Johnson's closing paragraph makes clear that she feels that hospice is overwhelmingly a good thing for patients. And hospice has clearly made substantial gains in what people can hope for as they face predictably fatal conditions. But hospice was designed around overwhelming cancer in relatively young patients (that is, under about 80 years of age). The prognoses of people dying slowly of the degenerative conditions of old age have unpredictable timing of death, need nursing care and housing more than opioids and counseling, and generally have needs that do not match the hospice paradigm. Furthermore, hospice is quite expensive, adding around $150 per day to the costs of caregiving, housing, food, direct bodily care, supervision, and long-term medications. It seems we might do well to take insights drawn from hospice - and PACE, and other innovative delivery systems - and build a program that fits this population even better.
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