Hospices: good news and bad

When the late Florence Wald ’41MN, ’56MS, a past Yale nursing school dean, helped establish the first US hospice in 1974, she and her colleagues embraced a nonprofit model. But for-profit companies have surged into the field in recent years: as of 2011, they made up 51 percent of all hospices.

Health policy researcher Melissa Aldridge ’05PhD and her colleagues have surveyed 591 hospices throughout the United States—about half nonprofit, half for-profit—to see how they differ. The results offer both “good news” about for-profits and “reasons for concern,” says Aldridge, now an associate professor at the Icahn School of Medicine at Mount Sinai. (Aldridge continues to collaborate with Yale public health professor Elizabeth Bradley ’96PhD and other faculty members, at Yale and elsewhere.)

Good news first. For-profits, which primarily serve patients in nursing homes and other long-term care facilities, were “more likely than nonprofit hospices to engage in outreach to low-income (61 percent vs. 48 percent) and minority communities (59 percent vs. 48 percent).” (The study was published online in February in the Journal of the American Medical Association: Internal Medicine.)

But for-profits were significantly less likely than nonprofits to engage in training future hospice health-care workers (55 percent vs. 82 percent). Moreover, for-profits had a higher disenrollment rate than nonprofits (10 percent vs. 6 percent). Patients can choose to leave hospice care voluntarily—if they’re improving, for instance—but “these are not people who are getting better,” says Aldridge. “Our earlier work showed that half of the people who are disenrolled die within three weeks, often in the hospital, which is not where they wanted to be.”