Is it really that difficult to find a hospice? Yes, it can be. It can be an overwhelming search for the totally uninitiated. And let’s face it, we are all uninitiated until we get that sobering life-limiting diagnosis or actual terminal prognosis. Remember what it was like sorting through all of the options available for the Medicare Health Insurance Supplemental Policy when you turned sixty-five? A Hospice search is even more intricate. And without the seminars to help guide the way.
However, if you pull the trigger on a Medicare Health Insurance Supplemental Plan that does not result in a good fit for your needs, you can drop it during the annual recertification period and register with a different company. For example, a consumer could elect to drop Humana and sign with AARP UnitedHealth. On the other hand, if your hospice provider drops the ball during your final hours on earth . . . you are at their mercy, which can lead to negligence or a holy mess.
What do families report that “holy mess” to be? Primarily, poor pain management, patient discomfort, and inconsistent service. No one wants to be in this disconcerting position in their final hours. It’s too late for major course corrections during the actively-dying phase. Family members often report harrowing experiences and relate stories about poor performance from their provider in the last forty-eight to sixty hours of a loved one’s life.
How many providers are “dropping the ball”? Too many. I know this response is not helpful which is why I am writing a book to help hospice consumers discern which providers are falling short and why. Consider my book to be an uplifting resource and a comprehensive seminar for selecting a hospice company.
What holds true for any type of medical treatment has to bear true for hospice care as well—you must advocate for yourself and your family members. Consumers should not automatically assume that their physician, the staff at a long-term-residential facility, or a health insurance provider can provide an objective or an informed referral. Most primary care physicians that I speak with admit that they know little about the hospice industry. Most importantly, for-profit providers compete for patients and may have a conflict-of-interest when soliciting new patients.
Why? Because often, interest conflicts are caused by competition, money, and incompatible needs or values between investors and patients. For example, many for-profit hospice companies might place investor requirements ahead of the needs of the patient. Where there is a conflict-of-interest, there is often a lack of transparency regarding a company’s true mission.
For example, in my former company, our Medical Advisors were also the Medical Advisors on staff for two different skilled-nursing facilities that we served. Those physicians influenced family decisions and were encouraging referrals to our hospice. They were eventually cautioned to drop the practice or lose hospice certification. Further, if a corporation ties bonuses to a healthy census, that’s a conflict-of-interest.
Also, health insurance providers, like Humana, have gotten into the business of acquiring hospice companies. Medicare beneficiaries might believe that it is advantageous to stay with the hospice company owned by their supplemental plan, not even aware that they are entitled to select any provider of their choice. Or worse, Humana makes decisions for their own financial benefit. For example, it might be more financially prudent for Humana to refer a patient for hospice than to pay for costly end-of-life treatment in a hospital. And because Humana recently entered the hospice business, they receive Medicare reimbursements for those patients. It’s a win-win for Humana.
As I have written in an earlier blog, in most urban and suburban counties, there might be fifteen to eighteen different hospice providers. It is a highly-competitive industry and marketers trip over one another to get families onto their census. Consequently, hospice is a nineteen-billion-dollar year industry.
In the current medical space, 85% of hospice providers are in the industry to make money . . . and for many, a lot of it. Hospice can either function as a corporate chain of agencies sprinkled across the nation, perform as a free-standing business or a hospice provider that operates as a subsidiary under one parent company with other diverse business entities. For example, Vitas hospice and Roto-Rooter (the Plumbing and Drain Service) are owned by Chemed Corporation.
There are excellent for-profit providers and many incompetent ones. As in all things in life, the reputation of a professional provider becomes tarnished amidst the headlines of the incompetent ones. In my role as a hospice consumer advocate, I want to promote and highlight the excellent for-profit providers. I believe in the hospice benefit and want to safeguard it. I believe that the movement has been corralled by Corporate America and the hospice patient has often become a business commodity.
Again, I cannot state strongly enough that consumers cannot wait until they are lying on an emergency room gurney, in the throes of receiving a life-limiting diagnosis or worse, to learn about hospice choices. You will not be in the driver seat if you postpone that decision. Similar to making your funeral plans years before you need to institute them, interviewing a hospice company before you actually need one is prudent.
According to an article by Jim Parker in Hospice News for September 2019, ninety-percent of adults over age sixty-five who entered the emergency room with a life-limiting illness (six months before death), did not have documentation for end-of-life treatment, nor any ideas on who might manage their dying process.
Subsequently, I have written my Advanced Directives and filed them with my physician. My children have been instructed on my wishes for end-of-life treatment (or lack thereof), and my preferred hospice provider. My first choice for a hospice provider would be a nonprofit, inpatient residence. Both of my parents died in those facilities and had comfortable and dignified deaths.
When hospice consumers ask me for advice about choosing a reputable hospice, I give these general guidelines:
- A healthcare system associated with a hospital often has an inpatient-hospice residence. And they are usually nonprofit (see my FAQ section on the difference between for-profit and nonprofit providers). In the Milwaukee area: ProHealth Medical System operates AngelsGrace Hospice, Aurora operates Zilber Hospice, and Horizon operates The Kathy Hospice on the campus of Froedtert and MCW St. Joseph’s Hospital. Horizon also operates the Lawlis Family Hospice facility inside the Columbia St. Mary’s Ozaukee Hospital.
- Finally, Rainbow Hospice is an independent, nonprofit inpatient Center that operates in Jefferson County. All of these residences also provide hospice in the home.
- Unity Hospice is a nonprofit, inpatient provider in the Green Bay area. It is excellent. My mother died there. She remained in her home until three weeks before her death.
- Christian organizations are starting their own hospices within their Elder Care Campuses. Luther Manor is a Protestant long-term-care facility and St. Camillus is a Catholic Campus in the Milwaukee area. Neither provider has a hospice inpatient wing, but they do provide care in their facilities and in the home. As well, the largest Catholic health system in the nation is Ascension (formerly Wheaton Franciscan Home Health and Hospice).
- The Agrace Hospice System is large and serves over 4,500 patients a year. It is a nonprofit provider that serves all of southern Wisconsin and northern Illinois. It was founded in 1978. It is noteworthy that Agrace has operated without a deficit for 38 out of 40 years.
- In my opinion, nonprofit-inpatient-hospice care is the Cadillac of current care. Secondly, having a nonprofit provider in a nursing home or at home would be my second choice (if a family can handle acting as the primary caregiver for their loved one).
- And there is no better referral to a particular hospice, than a recommendation by families with a great experience under their belt. Nothing beats word-of-mouth recommendations.
- Finally, for the hundreds of for-profit providers across each State, how does a consumer separate the “wheat from the chaff?” My readers keep asking when my book will be out with the resources they need to make a confident selection . . . hopefully soon.
Last week I interviewed the new CEO of Badger Hospice, Laura Kukowski. She began her career for Badger as the Director of Business Development and was then promoted to Executive Director. I had heard positive comments about this company and I wanted to get to know more about their philosophy and vision. My goal is to highlight excellent for-profit hospice providers for this blog.
Badger Hospice is a relative newcomer to the southeastern Wisconsin hospice space. While listening to Laura’s vision for this company, the sense that I got was that it operates like a family or a nonprofit—where the strategy, financial management, clinical protocols, and policies are instituted primarily for the benefit of the patient and their family.
One of the owners of the local company is, Barbara Horstmeyer. She states that the reason for starting this company was thus: “I thought that hospice was becoming too much of a business, so I gathered local healthcare providers who shared my concern (regarding the treatment of patients and their families) and founded Badger Hospice LLC.”
It was so heart-warming to hear their commitment to providing excellent care and placing the patients and their families as their primary stakeholders. Similarly, RN, Joanne Swanson said: “As a nurse and an owner of a Specialty Care Residence for older adults, I’ve had the opportunity to experience service by many different hospice providers over the years and it is clear that not all hospices are equal.”
The CEO of Badger Hospice understands that a for-profit business must balance making payroll and meeting expenses with sustaining the mission of good patient care. It’s not just about profit, but about purpose. It’s about meeting a human need and solving a human problem. As a consumer advocate, I want to help consumers locate a hospice business that can balance profit-making with the sustenance of a higher calling.
Badger fits into this model. It builds census through excellent care and word-of-mouth. It is building a census methodically and in an ethical fashion. It respects the professionalism of its staff and pays them accordingly. It has strategically organized its nursing shifts to maintain a safe and healthy work-life balance for staff and therefore, ensure good care for patients.
They are accredited by the Community Health Accreditation Program (CHAPS) for meeting high standards of excellence for community-based healthcare. What I noticed about Badger that I don’t see in most for-profit companies is that the CEO is a hands-on manager working in the office and directly oversees the staff. She knows the patients and their families. She has developed an in-office culture of transparency, honesty, and trust. She is a clear communicator and has systems in place to improve protocols. She really cares.
In conclusion, Badger Hospice recognizes that a staff treated with dignity lends itself to greater family satisfaction and a higher quality of care for the patient. That type of staff remains loyal. A stable staff with low turn-over is crucial to clear communication and consistency in the delivery of care.
Badger Hospice delivers on what counts.
Badger is located in Brookfield. I recommend them to hospice consumers who are looking for a provider that they can trust.