Efforts are underway in New York to ensure hospice care remains a nonprofit service, with advocates urging Governor Kathy Hochul to sign legislation aimed at curbing the expansion of for-profit hospice programs. The proposed bill, known as S3437/A565, seeks to protect the integrity of hospice care by preventing profit-driven entities from entering the sector, which many believe is essential for providing high-quality, compassionate care for terminally ill patients.
Advocates argue that hospice care, like hospital care, should be held to nonprofit-only standards in New York. Currently, approximately 70% of hospice facilities across the United States operate for profit. Research indicates that these for-profit hospices often engage in practices that compromise care quality, such as selectively admitting patients, reducing staff, and offering fewer services. This trend raises concerns about the overall well-being of patients who rely on hospice care during their final stages of life.
Critics of the bill contend that New York’s relatively low hospice utilization rate is an indication that additional providers, including for-profit entities, are necessary. However, this perspective overlooks key issues. The low utilization rate can be attributed to a lack of public and professional understanding of the Medicare hospice benefit, persistent misconceptions about hospice care, and a tendency for patients to be directed to skilled nursing facilities. These factors effectively hinder hospice enrollment rather than the availability of providers.
The New York State Department of Health administers a Certificate of Need (CON) process designed to evaluate healthcare providers before they can operate. Proponents of for-profit hospices argue that this process ensures quality and accountability. Yet, critics maintain that while the CON assesses operational feasibility, it does not adequately evaluate the integrity of a provider’s mission or their commitment to high-quality care. As a result, large for-profit chains may appear financially viable but fail to deliver the compassionate care that vulnerable patients require.
The limitations of the CON process also mean that systemic issues related to for-profit hospice expansion may go unaddressed. For instance, these entities may prioritize financial gain over patient care, leading to selective patient admissions and reduced nursing visits. Once a provider is authorized to operate, state intervention options become limited, often only addressing issues after harm has occurred.
Recent polling by Siena College revealed that a significant majority of New Yorkers support protecting the integrity of hospice care, with many advocating for a prohibition on for-profit hospices. The poll underscores a growing public concern about the potential for waste, fraud, and abuse associated with profit-driven hospice entities.
The proposed legislation aligns with the goals set out in New York’s Master Plan for Aging, which emphasizes treating older residents with dignity, respect, and compassion. Allowing the proliferation of for-profit hospices could undermine these principles, placing older adults at risk and threatening the continuity of care that families rely on during difficult times.
Having received bipartisan support, S3437/A565 is currently on Governor Hochul’s desk, awaiting her signature to become law. Advocates hope that swift action will reinforce New York’s commitment to high-quality end-of-life care for all residents.
