Re: The Dying


Those are terrible stories and unlike my experience with a not-for-profit hospice. My dad was bed-ridden at his house for 26 months with a degenerative brain disease until he died last December (2010). My stepmother and some visiting nurses took care of him most of that time. My stepmother called in the local not-for-profit hospice after Dad had a bad trip to the hospital with an infection in August (the hospital stopped the primary infection but the visit caused some other problems during treatment - he came out of the visit worse overall than when he went in).

The hospice folks visited him and helped care for him the last 3 months of his life. They did a good job of day-to-day care, raised his spirits, and also helped us figure out how to handle the situation as he deteriorated. His family doctor thought he would die in October - Dad made it through Thanksgiving which was a good thing for our family, as all his children and grandchildren and some nieces and nephews visited him while he was still alive (much reduced faculties, but he recognized most of us most of the time).

So hospice was a "good" experience for us and hopefully for Dad. My stepmother worked a lot with them, which itself was strenuous.

Posted by: bill | Link to this comment | 07-22-11 1:14 PM
horizontal rule

This made me just check whether the hospice that took care of my mother was for-profit. Despite the fact that they seemed to take wonderful care of her, I was fully prepared to be suspicious and angry. But it turns out they're non-profit! So, I'm assauged.

Posted by: urple | Link to this comment | 07-22-11 1:31 PM
horizontal rule

My uncle had a good experience with in-home hospice care. Well, he died, so not all that good, but the hospice care was supportive and helpful and made the process easier for him and my aunt.

This is the kind of issue where anecdotes aren't much help -- there are always going to be some bad anecdotes, and in this context bad means probably horrific. You'd need to have stats about how many problems there were compared to the number of hospice patients.

Posted by: LizardBreath | Link to this comment | 07-22-11 1:36 PM
horizontal rule

It seems like the kind of thing that demands a non-profit or not-for-profit (never sure what the technical difference is) approach for many, many reasons: keeping the systemic incentives in line with the mission, making sure the front-line workers don't have a reason to be cynical about what will be a sacrifice no matter what the organizational structure, and making sure that any excess is definitely ploughed back into the organization. It's also just an unseemly idea to have a for-profit hospice organization, I think. If hospice was something you really cared about, I'd think you'd be happy to build and grow a strong organization to give it without needing your payback to scale unendingly with that growth.

Posted by: Ile | Link to this comment | 07-22-11 1:38 PM
horizontal rule

Well, he died, so not all that good

Kinda seems like you're setting hospice up to fail, there.

Posted by: Sifu Tweety | Link to this comment | 07-22-11 1:43 PM
horizontal rule

No criticism of the hospice people, who were great, but the experience as a whole wasn't an unmixed good time. Pancreatic cancer: not a walk in the park.

Posted by: LizardBreath | Link to this comment | 07-22-11 1:45 PM
horizontal rule

Disagree with 4. Many not-for-profits are just as interested in earning as much money as possible for the "owner" (usually called "executive director") as a for-profit enterprise. The largest difference is that they call it salary, not profit, and the corporation is not taxed.

Posted by: unimaginative | Link to this comment | 07-22-11 1:49 PM
horizontal rule

Pancreatic cancer: not a walk in the park.
I don't know. Have you been outside today?

Posted by: Eggplant | Link to this comment | 07-22-11 1:52 PM
horizontal rule

8: Hott!

Posted by: JP Stormcrow | Link to this comment | 07-22-11 2:06 PM
horizontal rule

My grandmother is in a nursing home now, after a rapid decline over the last two months, which have included ER visits, hospital geriatric psych units, and an assisted-living facility that decided she was too disturbed for them after the second time she pulled the fire alarm in three days. She's currently on "comfort care", which I think is the conceptual equivalent of hospice treatment, but in their space. Unfortunately, she's still ornery enough to cause problems (barricading her room, scratching nurses) and the nurse-manager of her unit has told us to get private 24/7 babysitters or risk being kicked out of there, too. Which is ungodly expensive, since it's something like 3-4 full-time employees, and I sort of feel like the nurse-manager is making her staffing issues into my problem, when we're already paying for the nursing home care.

(And this is without getting into the insane family dynamics over whether I or the relative who is vacationing in a remote corner of Europe for three weeks hold the medical proxy. Not that we disagree on what should happen, but the nursing home is understandably wary of letting the wrong one of us sign off on anything)

Posted by: George Washington | Link to this comment | 07-22-11 2:55 PM
horizontal rule

the experience as a whole wasn't an unmixed good time

Yeah, the experience with my dad was wrenching and our family is still coping with it. Hospice helped us with a major part of it.

Posted by: bill | Link to this comment | 07-22-11 3:22 PM
horizontal rule

I knew someone who did business development for a for a couple of for-profit hospice organizations, and a co-worker of mine went to become a social worker for a hospice (don't know if that's non-profit). He feels like he's doing much more important and better work there.

7 is very true. Until quite recently, when a private equity firm bought out the Caritas Christi Catholci chain, there were really no for-profit hospitals in MA. (I take that back, the Arbour--a shitty system of for-profit mental hospitals--has been around for a long time.) Partners Healthcare (which encompassess Massachusetts General Hospital and Brigham and Women's) is non-profit, but it's the biggest employer in the state and merged to get better negotiating power with insurers. A lot of people in MA probably look down on for-profit hospitals, and my acquaintance who took her work seriously was from South Carolina, but she took some umbrage at the idea that MGH was more altruistic than they were, since they took Medicare too and MGH was just as interested in its bottom line.

Posted by: Bostoniangirl | Link to this comment | 07-22-11 6:38 PM
horizontal rule

My feeling is health care as a whole doesn't really know what it's doing - combine lots of traditions and norms with ever-changing reimbursement systems and a cascade of new technologies, shake vigorously - so bringing in the profit motive in the absence of effective quality standards is just one more of many systemic faults. Everyone in every sector is trying to maximize reimbursement; some have other priorities as well.

On the other hand, hospice care isn't so complex as curative - palliation, living assistance, etc. - so maybe for-profits have a greater share of the blame.

Also, the motivator for bad behavior at a nonprofit institution is maybe a cushy job of a million or so a year for you and your friends; at a for profit it might be hundreds of millions in windfall profits.

Posted by: Minivet | Link to this comment | 07-22-11 8:18 PM
horizontal rule


Posted by: Mister Smearcase | Link to this comment | 07-23-11 9:11 AM
horizontal rule

NMM to Amy Winehouse. Sad.

Posted by: politicalfootball | Link to this comment | 07-23-11 10:02 AM
horizontal rule