Aging | Hospice | Policy | November 29, 2022

Hospice: The New Yorker Letter to the Editors

BY Katie Smith Sloan

How Hospice Became a For-Profit Hustle” raises a serious cause for alarm about our country’s approach to long-term care while also providing valuable insights into bad behavior and illegal activity by some providers of hospice – a sector undergoing significant ownership transformation as once-dominant nonprofits are now significantly outnumbered by for-profit, increasingly private equity-backed, competitors.


The rise of for-profit and private equity ownership and an accompanying shift in focus to earnings growth have changed the sector. Fraudulent actors can thrive and this critically important benefit — unique for its foundation as volunteer-and-community-focused nonprofits — is tainted. As a result, a wealth of consumer trust, built over almost half a century of hospice activity in the U.S. and the legacy of nonprofit, mission driven hospice providers, many of whom are members of our association, are under direct threat.


Good hospice care, because of its holistic, patient- and family-centered compassionate approach to the dying, is a godsend. Bad care and true fraud in this valuable benefit are intolerable. Change is needed. Reform must promote high quality care, including the right services in the right quantity, and eliminate opportunity for misdeeds. Most importantly, our country is in desperate need of a system of long-term services and supports that is responsive to how older adults live and die now: enduring chronic illnesses, including heart disease and dementia. For older adults living with these diagnoses – and family caregivers – in-home support and holistic services provided by hospice are invaluable, and, sadly, too often unattainable.


America’s population is rapidly aging. Our mission-driven members, who offer services and help for older adults wherever they call home, know how to serve older adults. In hospice, and other settings, nonprofits are innovators in aging services, setting standards in quality of care and service. But without proper oversight and enforcement to ensure Medicare funds are spent as intended – solely for the benefit of those in hospice care – greed will prevail and sadly, more Americans will find themselves living – and dying – without the services and care they need.

Katie Smith Sloan
President and CEO
LeadingAge, the association of nonprofit providers of aging services, including hospice
Washington, D.C.