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From today's Guardian: "Private equity ownership of US hospice centers boomed in recent years – study""Investors spent about $1tn buying healthcare facilities over last decade, leading to reports of worsening patient care""Private equity investors are increasingly buying up hospice centers – healthcare facilities meant to focus on pain relief and emotional support for people near the end of their lives.""The new study was published in the journal Health Affairs and provides more evidence of how private equity have acquired firms using often sophisticated and opaque ownership structures.“Private equity is moving not just into hospice but every aspect of healthcare,” said Dr Vikas Saini, president of the Lown Institute, a thinktank that has been critical of private equity ownership in healthcare and who was not involved in the study.The reason private equity has become interested in healthcare, Saini said, is the industry “smells of money”. He added: “Their business is making money – it’s not taking care of people.”Private equity is a form of private, for-profit ownership that often involves asset management firms investing the money of wealthy individuals. Unlike publicly traded companies, private equity firms do not sell shares and are not required to report as much information.Although for-profit ownership is not new in US healthcare, the surge of private equity ownership is. Such investment groups have spent an estimated $1tn over the last decade, buying up hospitals and doctors’ offices. During that time, the industry’s interest in purchasing previously non-profit hospice centers has also grown.The new study published in Health Affairs found that private equity ownership in hospice facilities boomed over six years, with acquisitions growing from just a few in 2015 to nearly three dozen in 2021.While most firms acquired only one or two hospice facilities, at least one firm acquired 22 hospice centers spanning 10 states. Another acquired 14 hospice centers across four states. Most acquisitions were in southern states.Researchers were able to uncover the acquisitions by cross referencing a proprietary database of mergers and acquisitions used by investment bankers, called LevinPro HC, with federal government data on health facility ownership collected by Medicare, the public health insurance program for the elderly.Medicare, which provides near-universal coverage for the elderly in the US, is also overwhelmingly the largest payer for such services. It covers about 90% of all hospice patient days, according to the National Association for Home Care & Hospice.“That money is supposed to be spent providing the care and if you’re a for-profit entity you have every incentive to skimp on that care,” said Saini. “There is every reason to be very worried about this acquisition spree.”The American Investment Council, a trade association for the private equity industry, argues the industry “plays a critical role supporting quality, affordable health care in the United States”. The group did not respond to a request for comment.Research cited by Health Affairs’ new study found for-profit hospice centers are more likely to discharge patients before death, are more likely to transfer patients to hospitals and emergency rooms and have higher rates of complaints and deficiencies, research has found.About 486 US hospitals are owned by private equity firms, representing 30% of all for-profit hospitals in the country, according to the Private Equity Stakeholder Project. Similarly, private equity firms have also bought up doctors’ offices, increasing their ownership stake, according to the Commonwealth Fund.“Especially in the US, we have an ageing population with a chronic disease burden,” said Mary Bugbee, research and campaign director at the Stakeholder Project, which has also been critical of private equity’s actions in healthcare. “There’s a lot of demand and a lot of opportunities to make money.”And etc.

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I can't copy paste the entire article due to space limitations, but I have often talked about how much Hospice has changed since early days when they provided a real dedicated service tailored to each patient and individual. It is now simply a money-maker in which the Federal Gov pays out of Medicare millions of dollar so that two bed baths are given, and RN visits once a week, and you get a phone call from a social worker and clergy (maybe). My best friend spent her career in Hospice back then. It saddens me greatly that we are down to a "Hi-Goodbye" and a bottle of morphine for the billions invested.
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Private equity investing is in all aspects of US business, so this is no surprise. The article points out the obvious but then offers no solution. Citizens can choose to seek out non-profit and faith-based hospices. They can register their displeasure of the for-profit healthcare complex with their feet and wallets.
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Pretty much everything I know about American style Hospice comes from this forum so I may be off base but I imagine there are many small and rural communities where there is very limited choice in Hospice providers, people can't easily switch or opt for charities and faith based hospice if there's only one game in town.
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CW, I'm sure your right.

Something I've been wondering is if , hospice in general does more and is better towards dieing younger people.

My friends who's husband passed around 50 , hospice was so good to her. And I'm glad because she really really needed it.

But I've heard very little if any praise about hospice if it's an older person.

If anyone has any thoughts on that?
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@Geaton:
I so longed to get Hospice here during my nursing career. It was first here they say in the 1970s, but not until early 90s was it common and covered.
When hospice was first here, anyone with experience of what it is NOW would not have recognized it.
You were VISITED by Clergy, Social Services, Nurse managers, Aids and you were visited pretty much as much as you wanted or needed to be. ALL involved were specially trained and were marvelous, particularly with families. There was pain relief and explanations abounding. Someone was available at the dialing of a phone to come and help you. I can't begin to tell you how dedicated the teams were helping the families.

It is now rote. It is 2 bedbaths a week. One RN visit to check VS. Drugs (thank god). Equipment (some and thank god). A CALL from a social worker. A CALL to ask if you want clergy. A CALL if you do. And so on. SO MINIMALIST and with the caveat made clear that "we don't do that. You will have to hire on.............".

It is an entirely different animal and it is still paid the HUGE amounts allowed under Medicare as tho they were actually doing that work.
It is now the HONEY of all Hedgefunds. It is a real money maker.
You are correct. This is a consumer society and a military industrial complex. This is a for profit company. And if you have money, that's about all that speaks here.

I'm not saying I know a political system that works better. But when I saw recently what Italy will do in terms of genetic testing as compared to what the USA will do --and for FREE in their national health system--it quite knocked me off my feet. That led to the argument between significant other and I about longevity in which I took the LOSING position that we live longer in our health care system.
I lost the argument (happens way too frequently).
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Alva,
Thank you for posting this article from the Guardian. The Guardian is a wonderful source of unbiased, credible information.

I think as we age in the USA we're beginning to grasp the negative ramifications of hedge fund interference in healthcare. On the whole, healthcare has become shameful, negligent, and downright dangerous for patients.

My life goal was always to live to be at least 100 years old. Now, with the advent of Hedge Fund interference in healthcare my mindset shifted and my current medical directives are for strict minimal surgery, no chemo, palliative care only, DNR, no feeding tubes and Please drug me to the gills. Let me die as soon as possible with minimal medical "care". I hope by then medical assistance in dying will be available before I'm too sick to avail myself of it.

I will change these emergency advanced medical directives if/when Hedge Funds or similar organizations whose primary objectives are making money and profits for shareholders are prohibited.

Private industry has no right to be involved in healthcare!
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I'm curious to are Canadian friends, what's hospice like there?
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Anxietynacy - The provinces are in charge of administering healthcare so each one will be different. Here in Ontario there is no "Hospice" as such, it's all part of home care services although there are hospice facilities and usually a suite in every hospital. Palliative care is the same as hospice care, so once my mom's doctor decided she was palliative (not seeking curative treatment) that allowed mom to have an RN in the home as well as ensuring her DNR and after life arrangements were in place. My brother chose to go to a hospice facility for his final weeks, and my mom ended up in the nursing home so I haven't experienced a death in the home, but from what I'm told people are not lacking supports in that area. The posts about the American practice of basically handing family members a vial of morphine and expecting them to handle everything is horrifying to me.
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Cwillie, thanks for your response, 😊

And yes it is horrifying!
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I see hospice as being expanded to incorporate a MAID model. Like I said, my dad’s hospice chaplain participated in it legally already.
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I've been following this trend for some time, and I don't like it (for all the good that will do)! When Big Money starts being interested in healthcare, we can wave buh-bye to the "care" part. . . which apparently is happening. IMO, the care of vulnerable people should NEVER become a profit center for Big Money. Vulture capitalism will win every time.

I suspect that AlvaDeer, LostinPlace and I are pretty much on the same page regarding what we want--and do NOT want--at the end of our lives.
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Consumerism is the only power that the individual buyer has against big corporate interests. Of course I know that not every market has the availability of non- or not-for-profit alternatives, but it's the only thing that registers on their profit meters. Also, be vocal about local facilities on social media, like Nextdoor.com to inform others about the pitfalls of the for-profit places and what any of the options are. That's as much as anyone can do.
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