In the quiet corners of healthcare, there’s a conversation that needs to be had. It’s a conversation about hospice — a critical yet often misunderstood part of end-of-life care.
Many associate hospice with a grim and final act, but it’s so much more. Hospice offers comprehensive, compassionate care that addresses the physical, emotional and spiritual needs of patients and their families. The number of Americans ages 65 and older is projected to increase by 47% from 58 million in 2022 to 82 million by 2050. As our population ages and the demand for hospice care grows, significant challenges remain. We need to address the two elephants in the room: quality and accessibility.
Where we are now
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In recent years, private equity firms and large health systems have been scooping up hospice providers, drawn by the promise of steady reimbursement and growing demand. Nearly three-quarters of hospice care agencies are for-profit ownership. This trend isn’t surprising given our aging population, and the aggressive consolidation within the health care industry.
The impact of these acquisitions on the industry is complex. And even less understood than hospice itself. On the one hand, these investments can bring valuable resources to hospice care, funding geographic expansion, scaling technological infrastructure, improving facilities and enhancing services. Potential advancements include a centralized virtual medical center, automated scheduling and more seamless transportation when transitioning between care settings. On the other hand, a strong focus on efficiency and optimization has led to challenges such as staff burnout, higher turnover, and decreased patient satisfaction when compared with non-profits.
Coupled together, this complexity can contribute to reduced quality of care due to cost-cutting measures, aggressive marketing leading to overuse of services, increased billing and fraud and a lack of community investment. Not all for-profit hospices operate this way. But the link between for-profit status and these challenges, as highlighted in the Journal of the American Medical Association, underscores the need for a balanced approach that ensures financial sustainability without compromising patient care and community support.
Regardless of ownership, the challenges facing hospice care are numerous and daunting.
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First, inconsistent care quality perpetuates as the standard of care can vary widely from one hospice provider to another, with some offering exceptional support while others fall short. This inconsistency is a source of frustration for patients and families, who deserve the best possible care during a complex time, where emotions are high, and challenges can be significant.
Second, access to care is challenged by the persistent problem of workforce shortages. Demand for skilled nurses and other healthcare professionals is outpacing supply. Insufficient access to high-quality hospice services further exacerbates the problem, leaving many patients and their families with limited options and in some cases, an unawareness of the differentiation between what services are available to them.
Where we need to go
So, how can the industry help ensure that this vital service meets the highest standards?
With a focus on delivering compassionate and holistic care, non-profit organizations are uniquely positioned to help solve the current challenges with hospice. This alignment with their mission enhances their ability to collaborate with community organizations and health centers and systems, offering comprehensive and culturally sensitive care that responds to the needs of people in the community. Despite facing challenges like limited capital and infrastructure, non-profit hospices contribute significantly to a sustainable community healthcare ecosystem, especially under Medicare and value-based care frameworks.
Non-profits can further improve the quality of and access to care by working to integrate hospice into the full continuum of care, foster collaboration and drive innovation with technology.
First, it’s about the continuum. Hospice should not be seen as a separate entity but as an integral part of healthcare that needs to be discussed and planned for alongside other aspects of care. Education should be available to patients and families in a proactive fashion, cultivating information and data gathering necessary for making critical end-of-life decisions. Integrating hospice throughout the continuum of care can help ensure seamless transitions and better coordination of services. This can include working closely with primary care providers, specialists, palliative care teams and other healthcare professionals to develop comprehensive care plans and support difficult conversations about a patient’s end-of-life goals that address the unique needs and wants of each patient. Further, filling gaps in the continuum by providing support services such as grief counseling, support groups and resources for caregivers is another way non-profits can improve overall quality of care.
Second, we need collaboration among non-profit organizations. Pooling resources and expertise through the creation of consortiums and partnerships can help achieve economies of scale similar to that of larger for-profit or private equity-backed organizations, improve care coordination and enhance the overall quality of care. This type of collaborative model has proven successful in other areas of healthcare, such as federally qualified health centers (FQHCs), accountable care organizations (ACOs), and community-based organizations.
Together, non-profits can also play a crucial role in advocating for policy changes that support the advancement of high-quality hospice care. This includes pushing for better insurance coverage and funding for hospice services, as well as regulations that promote consistent care quality and cultural awareness.
Third, available technology is the key to unlocking breakthrough innovation. New digital solutions not previously used within hospice care can streamline administrative and documentation tasks traditionally done manually, freeing up time for nurses and care teams. For example, ambient listening and generative AI, designed to fit seamlessly into daily workflows, can significantly reduce inefficiencies and enhance care. Telehealth services and advanced data analytics can help providers better understand and meet patient needs, tailoring care plans more effectively, while also increasing access and facilitating connections with patients and families regardless of location. This is particularly beneficial for those who prefer to spend their final days in the comfort of their home.
The risks of inaction and the costs of maintaining the status quo underscore the importance of building hospice into the continuum, partnering together and investing in innovative tools today. Non-profits can raise awareness about the benefits of hospice and end-of-life care by educating patients and their families about the services available to them and how to navigate the healthcare system to access these services. And by reinventing processes and working more efficiently together to unlock funds for technological investments, non-profits can address workforce shortages, improve care quality and access, drive growth and set the stage for highly-reliable, continuous improvement and innovation.
The way forward
The conversation around hospice care is one that we can no longer afford to ignore. We need to talk about hospice because it’s not only a vital part of our healthcare system, but because we only have one opportunity to get it right for every person. It’s a place where compassion and dignity are paramount, where patients and families find solace and support during the most challenging times. We owe it to them to ensure that hospice care is of the highest quality, accessible to all and integrated into the broader continuum of care.
Let’s not shy away from this conversation. Let’s embrace it, knowing that by doing so, we can shape a better future for hospice care for each of us and our families.
Photo: LPETTET, Getty Images
Skelly Wingard is Chief Executive Officer of By the Bay Health. Prior to By the Bay Health, Wingard was Vice President of Continuum of Care for Kaiser Permanente, Mid-Atlantic States, where she led strategy and operations for hospital and post-acute services, emergency care management, health plan utilization, transportation, and regional care management. Wingard, who holds a Master’s Degree in Nursing from the University of San Francisco, began her career as a bedside nurse before joining North American Health Care in 2008, where she held clinical and administrative leadership roles. In 2012, she joined Ensign Services as Director of Nursing and was promoted to Vice President of Care Continuum in 2014. In 2017, she joined Kaiser Permanente Health Plan, where she held Continuum of Care leadership roles in Northern California. In 2020, she was elevated to executive leader, overseeing Continuum health plan operations in Virginia, Maryland, and the District of Columbia.
Asher Perzigian is a Managing Director and North America Care Innovation Practice Lead for Accenture Health and a recognized leader in commercializing and scaling innovative business transformation programs. Asher has worked with some of the leading healthcare providers, payers, vendors, and life sciences organizations in North America, and is responsible for Accenture’s relationship with one of the firm’s largest and most complex provider and care delivery clients. Asher lives in Chicago with his wife, son, and daughter and enjoys live music, hockey, running, and spending time with his large extended family. Asher is co-host of the Mavericks in Healthcare: Chronicles of Innovation Podcast Series.
Elizabeth Annis is a Senior Manager in Accenture’s Health practice. Elizabeth has worked with healthcare providers and payers across the US executing complex organizational transformations, ranging from operating model design to cost optimization. With a background in public policy and public health, her experiences across sectors enable her to navigate intricate industry challenges and achieve measurable improvements for clients. Elizabeth is passionate about using evidence-based solutions to drive effective operations and ensure affordable and accessible health care. Elizabeth has lived on both coasts and now resides in Washington, DC.
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