Two major shifts are transforming the landscape of hospice.

First, private equity firms are gobbling up hospices.  As Melissa Aldridge, a health services researcher and former banker explains, we should be very concerned.  Private equity firms try to turn companies as profitable as possible within 3-5 years.  Thus, they have little in the way of long term vision for hospices, instead focused on cutting costs and maximizing profits. 

Second, Hospice was originally designed for patients with advanced cancer, but the fastest growing admitting diagnosis is dementia.  People with dementia make up about half of hospice admissions.  And yet, we know little about the clinical experience of people with dementia in hospice.  Krista Harrison found, to her surprise, that caregivers of people with dementia who died rated hospice as well as similar patients without dementia who died on hospice.  And yet, disenrollment from hospice, either due to patient/family revoking the benefit or stabilization of illness (extended prognosis) is remarkably high for people with dementia among some hospices.  In fact, as Lauren Hunt found, the average likelihood that a person will be disenrolled from one hospice vs. another is two. In other words, which hospice you enroll in has a tremendous influence on whether you’re going to be disenrolled from hospice, which often feels to patients and families like being expelled.

And I had a blast playing Take the Money and Run!

-@AlexSmithMD