James Berklan

I have to admit I like it when our boys are back in the house. Now young adults living on their own, when they’re around the likelihood of finding what I want in the fridge may go way down but so do the odds of getting in trouble with their mother.

Clothes on the floor? Lights left on? Tonight’s intended dinner eaten early as a snack? The boys are liable to take a share of the heat, or earn the outright blame if something goes wrong. In other words: I’m in the clear. (OK, not all parenting involves taking positions with the highest virtues. But I know what gives a person relief and I’m not apologizing for it.)

To some degree, I imagine that must be what nursing home operators are feeling this week after one of its post-acute care siblings was thrust into the spotlight in a pretty bad way. On Monday, The New Yorker published a searing takedown of a large segment of the hospice industry. “How Hospice Became a For-Profit Hustle” is a journalistic gem that unrolls topics that have made many a long-term care provider squirm in the past.

It discusses the questionable pursuit of quotas that sound uncomfortably similar to what many therapy providers were accused of under the Resource Utilization Groups reimbursement system. The methods of drumming up business — via uneducated, unaware or simply healthy individuals — are worse than cringeworthy.

Then there’s the main focus of the piece: The huge upswing of for-profit providers in the hospice space. Just 30% of the market a few decades ago, they now hover at about 70%. That brings it to a similar level as their for-profit nursing home counterparts, though hospices rushed there much quicker.

Layer in the fact that private equity investment has soared in the hospice sphere recently and another familiar flashpoint for skilled nursing operators appears. The comparisons aren’t exactly equal, nor may the criticisms even be valid in some cases given the controversy over what constitutes “private equity,” according to many long-term care leaders.

But the fact remains that the spotlight on a whistleblower lawsuit that exposed dastardly practices by at least one major hospice provider isn’t good for anybody in the post-acute care sector.

 Skilled nursing operators are almost used to being accused of taking advantage of frail and elderly patients. Consider the vilification hospice providers now face since they deal with the frailest of the frail and sickest of the sick. Apparently, regulators haven’t even bothered to keep a close enough eye, though stricter monitoring seems all but a certainty in the future.

Professional caregivers inside and outside of hospice companies — as well as consumers at-large — can learn a lot from reading journalist Ava Kokman’s terrific coverage. Then pray she never has reason to report on them sometime in the future as well. 

It’s the kind of bullet no one wants to have to dodge, nor should they ever put themselves in the position of having to avoid.

James M. Berklan is McKnight’s Executive Editor.

Opinions expressed in McKnight’s Long-Term Care News columns are not necessarily those of McKnight’s.