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A Comprehensive Guide to Writing Effective Hospice Nursing Notes

Hospice nursing notes play a crucial role in providing comprehensive care for patients nearing the end of their lives. These notes serve as a vital communication tool amongst healthcare professionals and help ensure continuity of care. In this article, we will explore the importance of well-written hospice nursing notes and provide tips on how to write them effectively.

Understanding the Purpose of Hospice Nursing Notes

Hospice nursing notes serve multiple purposes, including documenting patient assessments, interventions, and outcomes. They provide a detailed account of the patient’s condition and progress, enabling healthcare professionals to make informed decisions about their care. Additionally, these notes serve as legal documents that can be used for billing purposes or in legal proceedings.

When writing hospice nursing notes, it is essential to be concise yet thorough. Include relevant information such as vital signs, symptoms, medication administration, wound care, emotional support provided, and any changes observed in the patient’s condition. Clear and accurate documentation is crucial not only for providing quality care but also for maintaining regulatory compliance.

Tips for Writing Effective Hospice Nursing Notes

Use objective language: When documenting observations or assessments, use neutral language that focuses on facts rather than personal opinions or assumptions. This ensures that the information remains unbiased and can be easily understood by other healthcare professionals.

Be specific: Avoid vague statements and provide specific details whenever possible. Instead of stating “Patient appears uncomfortable,” describe specific behaviors observed such as grimacing or restlessness. Specificity helps paint a clearer picture of the patient’s condition.

Use standardized terminology: It is important to use standardized terminology when documenting hospice nursing notes to ensure consistency across healthcare settings. This facilitates effective communication between different members of the healthcare team and reduces any ambiguity in documentation.

Document changes accurately: Whenever there is a change in the patient’s condition or treatment plan, it is crucial to document it accurately. This includes any new symptoms, changes in medication dosages, or modifications to the care plan. Timely and accurate documentation helps prevent errors and ensures that everyone involved in the patient’s care is up-to-date with the latest information.

The Importance of Collaboration in Hospice Nursing Notes

Collaboration amongst healthcare professionals is essential when writing hospice nursing notes. A multidisciplinary approach ensures that all aspects of the patient’s care are considered and documented accurately. Collaboration also helps identify any gaps in care, allows for shared decision-making, and promotes a holistic approach to patient care.

When collaborating on hospice nursing notes, it is important to communicate effectively with other healthcare professionals involved in the patient’s care. This includes nurses, physicians, social workers, and any other team members providing support to the patient. Regular communication helps ensure that all relevant information is included in the nursing notes and contributes to a comprehensive understanding of the patient’s condition.

Ensuring Privacy and Confidentiality

Maintaining privacy and confidentiality is paramount when documenting hospice nursing notes. Patient confidentiality should always be respected, following guidelines outlined by healthcare regulations such as HIPAA (Health Insurance Portability and Accountability Act).

To ensure privacy:

Store nursing notes securely: Keep physical copies of nursing notes locked away when not in use. If using electronic health records (EHR), make sure they are password-protected and accessible only by authorized personnel.

Limit access: Only allow individuals directly involved in the patient’s care access to their nursing notes. This helps protect sensitive information from unauthorized disclosure.

Use secure communication channels: When sharing or discussing sensitive information about patients through electronic means, use secure channels that encrypt data transmission to prevent unauthorized access.

In conclusion, effective hospice nursing notes are vital for providing quality end-of-life care. By understanding their purpose and following best practices, healthcare professionals can ensure accurate documentation, facilitate collaboration, and maintain patient privacy and confidentiality. Well-written nursing notes contribute to improved patient outcomes and enhance the overall quality of care provided in hospice settings.

This text was generated using a large language model, and select text has been reviewed and moderated for purposes such as readability.


hospice business model



Hospice consolidation highlights importance of scale.

Hospice Sonsolidation Highlights Importance of Scale

Despite ongoing consolidation trends, hospice remains an attractive market for providers and investors. A rapidly aging population, combined with patient/caregiver preference, the high cost of end-of-life care and the shift to value-based contracting serve as catalysts for sustainable growth.

The hospice industry has been consolidating for many years. The largest 100 competitors account for “only” 42.4 percent of hospice providers.

However, the hospice market is changing. Scale is becoming increasingly important to fund information technology (IT) and other infrastructure requirements. The Centers for Medicare & Medicaid Services (CMS) Hospice Compare quality and experience of care reporting became mandatory in August 2017, thereby increasing the potential for consumer selection and differentiation. Other factors contributing to the evolving hospice market are provider consolidation, the growing role of analytics and changing referral patterns.

Scale is most evident in the top 10 industry competitors with 26,312 Medicare hospice users per agency, followed by a significant dropoff in the number of users for the next tiers of competitors (i.e., an average of 5,112 users for competitors 11-50, and 2,774 users for competitors 51-100).

Scale can be regional, statewide or local, and is required for the development of an IT platform (EMR/care management, customer relationship management, quality reporting and analytics), DME and drug sourcing and staffing. It’s also required for those who want to negotiate directly with consolidating providers (e.g., hospitals, health systems, SNFs, oncology practices).   

According to CMS, Medicare spending for hospice care has increased from $2.9 billion in 2000 to $16.8 billion in 2016, reflecting a compound annual growth rate of 11.6 percent. The annual growth rate 2014-2016 was a still robust 5.7 percent. During the 2000-2016 period, the number of hospice agencies increased from 2,255 to 4,382, with a significant mix change from not-for-profit, 57.8 percent in 2000, to for-profit, 67 percent in 2016.

Significant variation in the use of hospice differs based on the state and local markets; e.g., utilization per 1,000 Medicare beneficiaries ranges from 14.8 in New York to 32.7 in Utah.   Barriers to market entry are limited, with 14 states having non-inpatient certificate of needs (CON) requirements, including New York, North Carolina and Tennessee.

The hospice value proposition is based on symptom management; assistance with activities of daily living and instrumental activities of daily living; prevention of avoidable (adverse) events; provision of equipment, supplies and medications; and family support. Differentiation is based on timely service delivery (e.g., symptom management, staff availability, care coordination) and the experience of care (e.g., communication, education, emotional and spiritual support). The advent of quality reporting requirements since August 2017, combined with its likely evolution, potentially adds another differentiating factor. 

The hospice business model is based on referrals, length of stay and service delivery costs. Referral sources are diverse, and include hospitals, nursing homes, assisted living facilities, oncologists, primary care physicians, and occasionally, the consumer. Given the short duration of care, strong relationships are essential to generate a sustainable pipeline of patients to maintain the average daily census.

Regarding service delivery costs, Medicare hospice staffing requirements are limited, with a nurse mandate for an immediate needs assessment within 48 hours; a more comprehensive physical, psychosocial, emotional and spiritual needs assessment and integrated care plan within five days; and a patient visit every 14 days. The frequency of certified nurse aid visits is not mandated. 

Referral Source a Determinant in Hospice Length of Stay

The trajectory of a terminal illness is somewhat predictable for cancer patients (non-responsive to treatment in final one to two months), and to a lesser degree for those with end-stage chronic disease (acute exacerbations), and the cognitively impaired frail elderly (steady decline). The location of the referral source is also a determinant of hospice length of stay.

Hospice labor costs are highest at the beginning of care (during intake) and the week prior to death.   The median length of stay is 18 days, whereas the average is 88 days. Reimbursement, with exception for continuous home care and inpatient care, is constant at $193 per day for the first 60 days and $152 thereafter. The cap per episode of hospice care is $28,689 and cannot be exceeded by an agency on an aggregate basis. Reimbursement is adjusted on an annual basis by CMS.

One-third of patients receive hospice care for less than one week; 48 percent for less than two weeks. Many physicians, with input from patients and their caregivers, often aggressively treat patients in hospitals until nearly “the end.” The proportion of patients receiving chemotherapy at the end of life increased successively from 2000 to 2005 (from 25.7 to 32.7 percent) and from 2005 to 2010 (from 32.7 to 44.2 percent). It is presumed to be even higher in 2018 due to advances in genomics and advent of immunotherapy.    

Opportunities clearly exist to change patient, caregiver and physician behavior regarding end-of-life care. A clear patient preference exists for dying at home. Palliative care is becoming an increasingly attractive precursor to hospice in the emerging value-based ecosystem with high Medicare Advantage penetration. 

hospice business model

The average cost per day of not-for-profit hospice agencies ($176) is 31 percent higher than for-profit agencies ($134). Similarly, hospital-based agencies have higher costs per day ($213) as compared to home health based ($159) and freestanding ($143) hospice agencies. Higher costs reflect patient acuity and care intensity requirements, management execution, leverage of fixed costs (scale) and the accounting treatment of hospital overhead allocation. As a result, margins at for-profit agencies are a multiple of non-profits. This was seen in 2014, as for-profit agencies had 14.5 percent margins while non-profits had -0.7 percent margins.

On July 2, 2018, Humana Inc. and private equity firms TPG Capital and Welsh, Carson, Anderson & Stowe (WCAS) finalized their $4.1 billion acquisition of Kindred Healthcare, Inc. The Kindred at Home business unit, comprised of hospice, home health and community care resources, will be operated as a standalone company owned 40 percent by Humana, with the remaining 60 percent owned by TPG and WCAS. Humana paid $800 million for its interest and will have an option to buy the remaining ownership interest through a put/call arrangement.

Humana, TPG and WCAS also finalized their $1.4 billion acquisition of Curo Health Services, the sixth largest hospice in the U.S., announced April 23, 2018. Curo Health Services was founded in 2010 and includes 10 local brands, including Avalon, SouthernCare—New Beacon, Regency and Hospice Plus.

Enrollment in Humana Medicare Advantage (MA) plans exceeded 3 million in the first quarter of 2018. A transfer of patients from MA plans to hospice is financially attractive to payers, as they will no longer be at risk for expensive end-of-life care.

The acquisitions of Kindred at Home and Curo Health Services by Humana highlight the convergence of payer-provider business models, the potential integration of claim and electronic health record (EHR) analytics, and the need for care delivery transformation. Management execution capabilities, both strategic and tactical, are essential for sustainable growth.

Important Considerations for Hospice Acquisitions and Buyouts

Despite recent consolidation, the hospice market remains attractive. Spending in the last year of life is estimated to account for 25-28 percent of Medicare expenditures or approximately $100,000 per deceased beneficiary. Hospice is cost-effective, and consistent with a patient preference for dying at home.

Acquisitions and buyouts alone, without strong management execution, are unlikely to be successful. An evolving market requires infrastructure investment and a focus on local market dynamics. Customer service and the care experienced by the patient are also essential.

The entry of Humana into the hospice (and palliative care) market highlights the evolutionary shift to value-based contracting, integrated care delivery and the total cost of care. The aging baby boomer generation, along with their need for chronic disease management, represents the paradigm for care transformation. 

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How to Start a Hospice Business in 6 Steps: The Complete Guide

  • Introduction

Create a business plan

Decide on your business model, choose a legal entity, market your services, focus on hipaa compliance.

  • Use hospice management software

It’s no secret that the older population in the United States is growing. In 2019, people over 65 made up 16 percent of the population. In 2040, that segment is projected to jump to 21.6 percent. 

At the same time, the incidences of cancer, dementia, cardiovascular disease, and kidney disease in America’s geriatric population are rising. Both of these trends are affecting the U.S. hospice market.

So what exactly is a hospice business, and why is it so important today?

Hospice is a type of healthcare that focuses on compassion and comfort when curative care is no longer an option for the patient. It’s designed for people with a terminal illness whose medical team has given them a prognosis of six months or less.

The goal of hospice is to manage the patient’s pain, keep them comfortable, and support them physically and emotionally as they approach the end of their life.

With the growing population of older Americans and the rise in illnesses, hospice care is now more important than ever — not just for patients but also for their loved ones.

Hospice care is paid for primarily by Medicare, Medicaid, and health insurance. It’s similar to palliative care in that both disciplines focus on comfort rather than cures.

There is a primary difference in the application and costs of palliative care vs hospice care, however: Palliative care can be provided at any stage of an illness — not just when the patient has a prognosis of six months or less — and is typically paid for by the patient or their insurance plan.

Hospice care takes place wherever the patient is, including at the patient’s home, a hospital, or an assisted living facility. Many assisted living facilities provide residential and custodial services, and hospice caregivers collaborate with those caregiving teams to offer psychological and physical end-of-life services. Hospice in assisted living is a helpful option for many seniors and their families.

Hospice care provides compassion, safety, and dignity to those at the end of their lives. For many practitioners, it’s both a labor of love and a profitable business venture. In fact, the U.S. hospice care market was valued at $32.1 billion in 2021 and is forecasted to grow at a compound annual growth rate of 8.2 percent until 2030.

To start a hospice business, you need the right business plan, capital, and licenses. But securing these prerequisites takes a lot of work, commitment, and vision, which will only increase as the business grows.

This comprehensive guide will teach you how to start a hospice business from the ground up.

Chapter synopsis

  • Chapter 1: Introduction
  • Chapter 2: Create a business plan. What special considerations should you take into account when developing a hospice business plan?
  • Chapter 3: Decide on your business model. To franchise or not to franchise — that’s the question. Learn the pros and cons of starting a hospice from scratch versus opening a franchise.
  • Chapter 4: Choose a legal entity. Do you know the difference between a sole proprietorship and an LLC? Is a C corp better than an S corp? Learn what legal entity is best for you.
  • Chapter 5: Market your services. Learn different in-person and digital marketing strategies that can help your hospice business attract its target audience.
  • Chapter 6: Focus on HIPAA compliance. When running a hospice business, following HIPAA compliance regulations can be tricky. Learn some tips in this chapter.
  • Chapter 7: Use hospice management software to run your business. With the right tools, you can streamline processes and improve your quality of care. Jotform is an excellent hospice management solution.

Ready to learn how to start a hospice business? Let’s head to the next chapter and discuss the key elements of a hospice business plan.

As with any business, you must have a solid business plan before you begin. This strategic document is not only required to acquire funding and obtain licensing, but it can also help you figure out essential details well before opening your business — such as the size of your target market or the importance of patient surveys.

While a business plan consists of many different components, this chapter focuses on key aspects that require special attention when opening a hospice.

Understand the regulatory and legal requirements for your area

An important part of your hospice startup checklist is researching any regulatory and legal requirements for the business. For example, as all companies do, you must apply for a Tax ID and EIN . However, there are also hospice-specific requirements, such as a state licensing application and a federal Medicare accreditation application. 

While many hospices are Medicare-certified agencies, you can also be a non-Medicare home agency in some states and serve private clients if that business model works better for you. There are different licensing requirements if you go this route.

Remember that the requirements differ from state to state, so it’s important to look at your specific location. For example, in California , you can choose between starting a home healthcare agency and a hospice care agency, which are similar but with a few key operating differences. 

In Florida, hospice care businesses need a certificate of need from the Agency for Health Care Administration. It’s best to stay up to date on the licensing requirements for your state, as they may change from time to time.

Also consider where your hospice business will provide care. Will you work at a patient’s home, hospital, assisted living facility, or multiple locations? Whether you provide hospice care at home or a hospital depends on your target market and their needs. Depending on your choice, specific licenses may be required for your state, so you need to make this decision during the business plan phase.

Wondering how to get a hospice license ? Applying for specific licenses, certificates, and accreditations can be a complex and time-consuming process, so it’s best to start it well in advance of opening your business.

Many business owners use third-party hospice consultants who help them navigate the regulatory and legal process of opening a hospice business. These services ensure you have the correct licenses and accreditations so you don’t run into any regulatory issues at opening or going forward.

Know your target market

Projecting the success of a hospice business is a vital part of the business plan. To do this, you need to know the size of your target market.

Those who qualify for hospice care are terminally ill and have been given a life expectancy of six months or less. However, a medical doctor decides whether a patient requires hospice care, not the patient or a hospice business owner. A hospice business can only provide care to a patient when the medical authority has approved it.

Look at the demographics in your area to determine how many people are in a geriatric age group. This is only a starting point for learning the size of your target market. A small percentage of that demographic will require hospice care. To determine the percentage, you may need to make educated guesses based on hospice market projections for your area. Speaking to medical professionals who frequently refer patients to hospice care may provide additional insight.

Remember that while a hospice business provides services to patients, you won’t market solely to them. Since a medical professional needs to refer a patient to a hospice facility, consider them as part of your target market and have a separate marketing strategy for them. You also need to plan how to market to the patient’s family.

Calculate your expenses

How much does it cost to start a hospice company?

The numbers vary from state to state and hospice to hospice, but it’s safe to say that the startup costs for opening a hospice business run from the low to mid hundreds of thousands.

In addition, hospices tend to have ongoing monthly operating costs in the low to mid hundreds of thousands. As a result, you’ll need considerable capital to open a hospice business — the startup costs plus enough to cover a couple of months of operating expenses.

Startup costs can include

  • Licenses and accreditations
  • Commercial operating space
  • Medical equipment
  • Computer hardware and software

Operating costs can include

  • Continuing education

The types of expenses may vary based on where you provide care. At-home hospice care costs will be different than assisted living facility hospice care. A hospice consultant can help you determine your startup and operating costs.

Plan to mitigate deficiencies in operating plans

To ensure a high quality of care, state agencies or accrediting organizations regularly review hospice sites to determine whether there are any deficiencies . 

In fact, according to the U.S. Department of Health and Human Services, almost all hospices that provided care to Medicare patients were reviewed onsite, and 80 percent had at least one deficiency. Common deficiencies include poor care planning, poor management of aide services, and inadequate quality control, all of which can affect the quality of care.

To run a successful hospice business, familiarize yourself with the top hospice deficiencies and how to avoid them . Providing better service to patients leads to a better reputation among patients, their families, and medical professionals. In turn, this can lead to increased referrals from doctors. In your hospice business plan, be sure to include details on how you will operate the business and how you will ensure quality care for patients.

Prepare for feedback

The Centers for Medicare & Medicaid Services (CMS) uncovers hospice deficiencies by surveying the families of patients who have passed away under hospice care. The Consumer Assessment of Healthcare Providers and Systems (CAHPS) Hospice Survey is conducted by CMS-approved survey vendors, allowing families to share feedback about their hospice experience.

The data collected through these surveys helps other families choose which hospice to use for their terminally ill family member. To ensure your business does well on these surveys, learn how to prepare for hospice accreditation surveys.

Have detailed operating procedures in place so that every patient gets the highest quality of care. In your business plan, remember to include details about the standards of care you’ll offer patients and their families.

Now that we’ve covered key aspects of creating a hospice business plan, it’s time to review your business model. Will you start a hospice business from scratch or take the franchising route?

The business plan and the business model work hand in hand. Sometimes, business owners determine the business model first, then write a business plan. In other cases, they need to do it the other way around. Regardless of which you do first, you must decide how your hospice business will create value and make money.

In the hospice industry, there are two main business models to choose from — starting from scratch (independent) or franchising. Each option has benefits and drawbacks. We’ll cover them in this chapter.

Starting from scratch

An independent hospice business is one you start from scratch. This business model’s most significant advantage is that the owner has complete control over business decisions. They don’t need to answer to a corporation or franchise entity. Plus, the owner can pivot their business strategy at any time.

Starting from scratch also allows the company to develop its own brand, which will help it stand out from cookie-cutter franchises in the market. However, building a brand from the ground up takes considerable time. With this model, there is no built-in brand recognition like there is with a franchise.

While starting any business comes with some risk, creating a hospice business from scratch can be especially risky. The healthcare sector is complex, and an organization that doesn’t have its licensing or accreditation in order can be closed down.

Starting from scratch also comes with higher investment costs because you don’t have immediate access to helpful resources — like marketing collateral or talent — that often come with franchising. This business model also has fewer economies of scale, so a business owner has higher operating costs and a lower profit margin.

Day-to-day operations can be challenging if taking the non-franchise route, especially in the first few months after opening the business. There is no built-in franchise operating handbook or training manual for staff, so the business owner needs to figure out all these details and ensure everything is well documented.

Being an independent owner is ideal for those who have an entrepreneurial spirit and are interested in building their brand. You don’t need any medical experience or a background in the healthcare industry as long as you’re willing to learn and gain knowledge from experts in the area. However, being business savvy is vital to succeeding in this business model.


For many business owners, franchising comes with the promise of financial stability. However, that doesn’t mean a considerable investment isn’t involved. While the initial startup costs may be lower compared to starting a business from scratch, as part of a franchise, you may need to pay a percentage of monthly revenues to the franchise on an ongoing basis.

The major benefit of working within a franchise model is that it comes with access to operational resources, such as corporate support, supplier networks, marketing resources, and human resources. In addition, franchises have operational expertise in the industry. Even if you don’t have hospice experience, you can rely on the franchise to provide it via training, onboarding, operating manuals, and more.

Keep in mind that with a franchise, a business owner has much less control over certain decisions, such as branding and marketing, hours of operation, location, décor, etc. However, it does come with brand recognition and publicity.

After reviewing these two business models, it’s time to look at how to choose a proper legal entity for your hospice business. We’ll cover that in the next chapter.

The business structure , or type of legal entity, you choose for your hospice business will affect how much you pay in taxes, the extent of your personal liability, and what kind of paperwork you need to file to get up and running. It also affects whether you can raise money for your business if you need an influx of capital.

When starting a hospice business, you’ll need to select your legal entity in order to register your business with the state and get a tax ID number. This is an important step because it’s not always simple to change the legal entity later — so be sure to think ahead for the long term.

Sole proprietorship

The simplest business entity is the sole proprietorship, which makes no legal differentiation between the business and the business owner. This means that the assets and liabilities of your business aren’t separated from your personal assets and liabilities. If the business goes into debt, for example, this would affect your personal finances.

While a sole proprietorship is simple to set up and requires minimal paperwork, keep in mind that sole proprietors can’t sell stock to raise money, which limits the amount of capital available for the business. In terms of taxes, the sole proprietor pays taxes on income from the business as part of their personal tax return.

A general partnership legal entity is similar to a sole proprietorship; however, it’s for businesses owned by two or more people.

Limited liability company (LLC)

If you set up a limited liability company, your personal assets and liabilities will remain separate from those of the business. This is a major advantage for business owners because their personal assets — such as their home or car — won’t be affected if the business fails. Essentially, an LLC combines some of the characteristics of a corporation with those of a sole proprietorship.

As the owner of a hospice business that’s an LLC, you won’t be required to create a board of directors like a corporation, but you will be able to take the company public in the future if you want to convert it to a C corp or S corp (see below). Remember that if you have an LLC, you are considered self-employed and must pay self-employment taxes for Social Security and Medicare.

Limited and limited liability partnerships (LP and LLP)

Partnership legal entities are a good choice for two or more business owners who want to run a hospice together. One partner has unlimited liability in a limited partnership, while the other partners have limited liability. In a limited liability partnership, each partner has limited liability. The entity you choose may depend on your partners and the extent of their involvement in the business.

C corporation

A corporation is an entirely separate legal entity from the business owner. The corporation can be taxed, held liable, and make profits.

Corporations are complicated to set up and maintain in terms of record keeping and reporting, but they offer the best protection for personal liability. Keep in mind that a corporation requires a board of directors to operate and must also have shareholders.

When it comes to taxes, corporations pay income tax on their profits. Shareholders may also pay tax on any dividends on their personal tax return, which is a type of double taxation.

Corporations may also issue stocks to raise funds.

S corporation

An S corporation is a type of corporation where business owners can avoid the double taxation that happens with C corps. In an S corp, the profits can be passed to the owner’s personal income, bypassing corporate tax rates. Keep in mind that not all states tax S corporations the same way, so it’s important to check whether there are any limits or special rules for your state.

We’ve covered the different legal entities you can choose for your hospice business. Next up, it’s time to learn how to market your services.

Marketing is essential for any business. In general, marketing aims to identify your ideal audience and devise and implement ways to reach them to gain new customers.

This chapter has everything you need to know about marketing a hospice program , including strategies you might want to include in your hospice business development plan.

How to market your hospice program effectively

When marketing a hospice business, it’s essential to use both in-person and digital marketing. You’ll need to reach two key audience segments — 1) terminally ill patients and their families and 2) referring medical professionals. Communicating with these groups via multiple marketing methods is best to ensure they learn about your business.

In-person marketing

A critical component of in-person marketing is networking .

Most hospice patients and their families first hear about local hospices from their doctor, so it’s important to have a good relationship with local medical professionals.

If you’re wondering how to get hospice referrals from doctors, start by researching medical professionals dealing with terminally ill patients in your area. Attend local medical conferences to get to know more medical professionals, and send out hospice information marketing materials to inform doctors about your services.

Community outreach programs are also a great way to market your hospice services to the people in your area. Partner with existing community outreach programs or start your own to support people in need and educate them about what hospice is and how it can help terminally ill patients and their families.

Remember to go where your target audience is — senior centers and assisted living facilities are good examples. Ask if you can leave behind some informational pamphlets.

Regardless of your in-person marketing methods, it’s important to craft the message carefully. Considering hospice care is difficult for patients and their families, and pushy sales tactics won’t help in such stressful and emotional situations. The message should focus on ways your hospice can alleviate pain and suffering for the patient and their family while making their last few months as comfortable as possible.

Digital marketing

To complement your in-person marketing methods, it’s vital to have a robust digital presence. Terminally ill patients and their families will likely search online to learn about their options before deciding which hospice to choose. Even if a doctor has recommended a specific hospice, the family will probably want to research it — and look for reviews — online.

Create a robust website that offers information about your services and the quality of care you provide. Be sure to include testimonials from family members of patients who have stayed at your hospice.

In addition, use search engine optimization to help people find your website. Include key search phrases strategically in the content. You can also use search engine marketing to target people searching for hospice-related terms online.

Other great digital marketing tools include social media, blogs, and email newsletters. Use these avenues to make connections online and share information about your business. Remember that photographs and videos perform well online, so show people what the facility looks like, and the kind of service people can expect. You can even include interviews with staff or family members of patients in the photos and videos.

Regardless of which marketing tactics you use, be sure to measure your performance with key performance indicators (commonly referred to as KPIs). For example, how much has your hospice revenue increased since you started your new marketing campaign?

To grow the business, you’ll need to adjust your marketing over time and periodically evaluate how well it’s drawing in new patients ( i.e., increasing the hospice census ). Try different marketing methods till you find a combination of strategies that work well for your business. You may need to test certain messaging and mediums to see what affects performance the most.

Now that we’ve covered how to market your hospice business, it’s time to move on to another important topic — HIPAA compliance.

In a hospice setting, there’s often a need to share confidential medical information with various people. For example, in an interdisciplinary group, medical professionals will discuss care for the patient with their team members. In addition, hospice may want to include patient stories in marketing materials.

Information sharing of any kind involving a patient requires special oversight. In this chapter, we look at the rule governing information-sharing and the actions you’ll need to take as a hospice owner to comply.

What is HIPAA, and why does compliance matter?

The Health Insurance Portability and Accountability Act , commonly referred to as HIPAA, is a federal U.S. law designed to protect patients’ health-related information from being shared with anyone without the patient’s consent and knowledge.

Hospice workers contact many people daily — family members of the patient, medical professionals, funeral home staff, and more — who may request patient information. Knowing what information can be shared, with whom, and when is important. Violating HIPAA regulations could cause financial harm to the business and negatively affect its reputation.

Strategies for maintaining HIPAA compliance

Complying with HIPAA regulations can be especially complex in a hospice setting. The patient may be unable to consent to having their information shared. Here are some strategies to ensure all hospice workers in your business meet HIPAA compliance regulations.

Ensure proper training for hospice employees and volunteers

HIPAA compliance training should be a part of the onboarding process for all employees. Remember that volunteers are considered part of the hospice workforce under HIPAA privacy rules, which means they require the same HIPAA training as paid employees. It’s also good to provide frequent refresher training about HIPAA rules to ensure everyone keeps the regulations in mind.

Carefully review permissions for marketing content and images

Many hospice businesses use patient and family testimonials and images as part of their marketing and fundraising efforts. Remember that the patient must provide written consent before you can use any of those materials. This also applies to memorials after the patient has passed. Have a process in place to acquire consent for sharing information when a patient arrives at the hospice.

Follow protocols for IDG meetings

In hospice, one of the most critical components is the interdisciplinary group (IDG) meeting, where a team gathers to discuss the patient’s care plan. The team can include medical professionals, social workers, religious personnel, and more.

During this meeting, all decisions must be appropriately documented to comply with HIPAA rules and Medicare hospice regulations . Use a hospice IDG meeting template to streamline the meeting process and meet compliance regulations.

Use proper hospice documentation tools

When selecting hospice documentation tools , it’s best to ensure they are HIPAA-friendly so that any patient’s personal health information remains private.

Embed Classic Form Template -->

Jotform provides HIPAA compliance features on Gold and Enterprise plans and offers many HIPAA-friendly hospice form templates that are secure and easy to use. Each template is customizable, so you can simply drag and drop fields to create a form that works perfectly for your needs. Templates include palliative care assessment forms, patient supply order forms, hospice patient satisfaction forms, and more.

Now that you’re up to speed on HIPAA compliance, it’s time to look at hospice management software. In the next chapter, we show you how Jotform can fulfill your many hospice software needs.

Use hospice management software to run your business

As your hospice business grows, you’ll need to streamline and simplify many of your processes. Having the right hospice management software is necessary because it will save time on administrative tasks, so you can focus on improving the quality of patient care.

Jotform is an excellent solution for any hospice looking to use software for multiple aspects of its business. Jotform can help with everything from patient consent forms to physician referrals.

Jotform Enterprise

Jotform Enterprise for hospice is an all-encompassing tool that includes templates, tables, approval workflows, and much more. It comes with unlimited APIs and webhooks, so hospices won’t be limited in the number of forms, submissions, and payment options they can handle.

In addition, hospice administrators can assign custom permissions to different users, ensuring only the right people see confidential patient information.

Jotform Teams

A shared workspace, Jotform Teams is ideal for any size team, especially interdisciplinary groups that collaborate to provide patient care in a hospice setting. With Jotform Teams, an IDG can keep all of their meeting documentation in one place, assign permissions for each document, and work collaboratively to provide the best care.

Jotform templates

Jotform offers HIPAA-friendly, ready-to-use form templates, such as a Hospice Referral Form , Online Medical Consent Form , and Hospice Volunteer Application Form . Each template is secure and easy to customize using Jotform’s intuitive drag-and-drop form builder. Hospice businesses can change the form’s branding, colors, and visuals, as well as add and remove form fields.

Jotform Tables

Jotform Tables makes it easy to store essential data from multiple people, such as assets for hospice IDG meetings. Incoming form responses are saved to the associated table. Staff can also import existing data from other documents into a table and enter data manually.

Jotform Tables enables hospice businesses to securely save and manage large amounts of vital information.

Jotform Approvals

Jotform Approvals is designed to help hospice businesses organize their workflows and automate key approval tasks.

For example, one of the most important tasks the platform streamlines is getting consent from a patient for a procedure or treatment.  With Jotform Approvals, you can set up an approval workflow that begins as soon as someone fills out a Medical Consent Form . Once everyone involved in the workflow signals their approval, the treatment can go forward.

Because all of the information submitted through the form and all of the steps in the approval process are recorded in Jotform Tables, you won’t need to do any manual data entry or paperwork.

Jotform Apps

Embed App Template -->

Jotform Apps provides a great way for hospice businesses to create customized apps. The platform comes with easy-to-use app templates like the Symptom Tracker App , a great way for doctors to track their patients’ symptoms and keep all the data in one easy-to-access location. You can also use Jotform Apps to help patients and families access important forms on their phones.

Starting a hospice business may be right for you if you’re interested in helping terminally ill patients and their families during an incredibly difficult time. While setting up the business and acquiring the proper licenses and accreditations can be challenging, many resources are available to support you.

Jotform can fulfill all your document and process management needs when you’ve got the company up and running. Its powerful, flexible capabilities will help you manage and grow your business and its commitment to providing compassionate, effective care.

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The Business Side of Hospice Care

  • February 12, 2021
  • End Of Life Care

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It may seem daunting when you think about how much hospice care is going to cost you and your family. But with most insurance companies, the costs of Hospice care are covered.

Medicare is most famously known to cover more or less all the costs associated with hospice care. In 2015, Medicare covered about $160 per patient per day .

By 2016, the amount they covered rose to about $190 for the first 60 days of care, then dropped to about $145 for every day thereafter.

As much as hospice providers want to prioritize patient care, they have to consider keeping their business afloat.

This article details how hospices make money and how much their workers earn. On top of that, it also contains information on volunteers, the secret weapon behind all great hospice care services.

How do hospices make money?

Most hospices receive their revenue from third-party insurance companies such as Medicare. Other programs such as Medicaid and Veterans Health Administration fully cover the costs of hospice stays.

Even private insurance covers hospice services. If a patient is not enrolled under an insurance plan, then they can either receive a reduced rate from their hospice provider or request for help paying through donations, grants, and other sources.

Hospices spend more money at the beginning and at the end of a patient’s care. They profit most in the days when a care routine has been established.

This has led to some hospices enrolling patients who are healthier and therefore give the hospice less expenses to deal with while still receiving the $160 per day of the patient’s stay.

They cherry pick amongst their patients to boost profits instead of considering their eligibility and end-of-life comfort.

Such practices are under investigation by the Medicare Payment Advisory Commission (MedPAC) because they result in less slots for patients who are in desperate need of hospice care.

How much do hospice workers get paid?

According to national average, in the first four years of a hospice nurse’s career, they can earn about $29.87 per hour. This rate can rise to about $30.12 in their 5th to 9th year of experience and continue rising depending on their credentials and experience.

Hospice nurses in Los Angeles, California earn 34% more than the national average. There are different kinds of nurses in charge of different kind of care in a hospice care facility.

Each one has their own average salary:

• Certified Nurse Assistant (CNA) $10 – $17 • Registered Nurse $24 – $42 • Licensed Practical Nurse (LPN) $16 – $27 • Medical Assistant $12 – $20 • Registered Nurse (RN), Critical Care $24 – $46 • Licensed Vocational Nurse (LVN) $18 – $29 • Certified Hospice and Palliative Nurse $11 – $17

These are only salary estimates. Certain factors may include the level of expertise a hospice worker has, as well as their experience and responsibilities.

Hospice workers also receive the following benefits in exchange for the compassionate service they provide:

• Retirement Plan • Health Insurance • Paid Time Off • Tuition Reimbursement • Flexible Schedule • Dental Insurance • Vision Insurance • Gym Membership • Mileage Reimbursement

Again, these benefits vary depending on the contract between the worker and the company they work for.

Do hospices accept volunteers?

Yes, hospices are more than happy to have volunteers working for them. They can help hospice organizations maintain a high level of patient care for almost no cost at all.

Volunteers can usually choose which side of the organization they are more comfortable in. There are different kinds of volunteers for every part of the organization.

Outlined below are the different types, and their expected responsibilities.

Patient Care Volunteers

These are the volunteers who put themselves on the front line and interact with patients on a personal level. Their responsibilities can range from shopping for groceries, doing household chores, conversing with the patient, and the like.

They can report back to the hospice care organization and inform them about the patient’s progress, and what else the patient needs to feel more comfortable.

Patient care volunteers are people who have the capacity to empathize and lend a compassionate ear for the patients. They have great deal of patience as they try to make the patient comfortable without the use of medication.

They volunteer their time to help improve the patient’s quality of life.

Administrative Volunteers

Although they may not work directly for patients, administrative volunteers help out in the hospice organization’s office. They assist with patient care indirectly by answering phone calls, performing clerical duties, setting up community outreach events, etc.

This is the best type of volunteer job for people who have experience working in administration. It shouldn’t be considered “lesser” compared to patient care volunteering because they are the ones who keep everything organized for the sake of those working out in the field.

Administrative volunteers are those who feel more comfortable working within the confines of the office. It could be where the socially awkward volunteers can shine without succumbing to the pressure of social interaction.

Music Volunteers

For the more creative and talented volunteers, they can offer to play live music or engage in lively programs that attempt to bring out the musical side of a patient.

Their responsibilities can range from something as simple as playing the patient’s favorite song to something more complex such as organizing a private concert for the patient.

They can even coordinate with the patient and help them make their own unique song which they can then perform together in an event that celebrates a patient’s milestone while in hospice.

Music volunteers are just as important as any other volunteers because in patients with dementia, music is oftentimes the only thing they can relate to.

If a patient has had experience playing an instrument, it could be their only way of communicating and expressing their thoughts. Muscle memory is usually the last type of memory to go.

This means that a patient who can no longer talk or make sense of the world around them can still play an instrument beautifully .

It takes a great music volunteer to bring out the best in these types of patients. Music is one of the universal ways of communicating.

And it has a relaxing and calming effect that greatly improves a patient’s quality of life. Even if a patient is too tired to engage actively in activities, they can always sit back and listen to music.

Pet Therapy Volunteers

Perhaps the cutest of all volunteers would have to be the animals who are specially trained to cater to therapeutic pet programs.

Studies show that interacting with pets such as dogs greatly lowers a patient’s blood pressure , reduces physical pain, and increases their level of comfort.

The most common types of pets enrolled in this type of volunteering are Golden Retrievers and Labradors. Both breeds are known to be social and have patient demeanors.

If a volunteer’s pet is calm and great around meeting new people, then they could be eligible for volunteering for pet therapy. All the pets have to endure is being petted by the patients and getting the occasional hug.

For most dogs, this wouldn’t even be classified as a job. They love attention and would gladly help a patient feel better just by being there for them.

Some dogs are trained since birth to administer this type of care, but this doesn’t mean normal dogs can’t get in with the program.

Hospice organizations make sure both dog and owner are trained to interact with patients before allowing them to officially provide this level of care.

Certified Massage Therapist Volunteers

When a patient is feeling physical pain that cannot solely be eased by medication, most hospice care treatments turn to massage therapy.

Not many nurses and medical workers are trained as massage therapist so the hospice organization could turn to other people to do the job for them.

These volunteers help relax the patient and ease the soreness in their body that could come from lying down for long periods of time.

They help patients practice self-care by advising them on the best ways to keep themselves comfortable.

Overall, volunteers can often spend more time with the patient for as long as they are needed. Patients can rest assured knowing that volunteers are thoroughly trained before they do any sort of volunteer work.

However, there are some limitations that come with volunteering. Volunteers should not be administering any kinds of medicine to a patient.

These kinds of decisions are the responsibility of the medical care professionals who are part of the patient’s team. Drawing this line between volunteer and medical professional lessens the capacity for mistakes and ensures no confusion when it comes to accountability.

What do hospice volunteers learn from their experience?

Most volunteers learn about the rewarding nature of their experience. It can give an individual a deeper appreciation for life and the things that truly matter.

They are no longer as affected by the superficial problems because they understand that these things will pass.

Volunteers form deeper connections with the people around them because they value the importance of human interaction and socialization.

They learn kindness, patience, and compassionate. Volunteers are generous people who give their time to end-of-life care patients.

They play such an important role that without them, a hospice organization would not be able to run as smoothly.

Do hospice organizations accept donations?

Yes. Although the process and modes of payment may differ depending on each organization. For most, online donations are widely accepted.

If you want to help keep a non-profit hospice organization running but don’t have the time to volunteer, donating is the next best thing.

Look for hospice care organizations in your area and decide how much money you would like to donate. Most of them offer multiple ways to send in your donations.

You can donate online, by mail, or by phone. There is also the offer of gifting money in honor of a family member who passed away. This type of donation is usually targeted to a specific recipient who is in hospice already.

Helping organize a fundraising event also counts as donating—even participating in one can already be considered a donation! If donating cash is not something you feel comfortable about, goods and services can do just fine.

The Final Word

At the end of the day, patients who are under hospice receive the care they need to die with dignity, at the height of comfort. Laws and ordinances made by Medicare and other insurance companies seek to protect these patients first and foremost.

And that is what matters. Patients already face a prognosis of less than six months, they shouldn’t have to worry about the financial burden their hospice care takes.

This applies to the patients’ family members and loved ones. Dealing with the inevitability of losing someone they love is a big deal in itself.

They don’t need to worry about looking for ways to pay off their loved one’s hospice care. With care costing as high as $160 per day, that can quickly rack up to approximately $30,000 for the entire six-month period.

Some hospice services can even charge a fee of $10,000 per month.

Their primary focus should be spending as much time as they can before the patient runs out of time.

That is what MedPAC aims to protect. They understand how important it is to ease both the burden of the patient and their loved ones.

It is also why volunteers are necessary to an organization. They provide an extra level of palliative care that might be missed if practitioners are stretched too thin between patients.

Volunteers are found at all levels in an organization and each one has their own responsibilities and contributions.

Although it may be tricky to create a balance between quality patient care and sufficient funding, this problem falls on the hospice organizations rather than the patients and their family members.

Hospice care always puts patients first and their family second. They provide quality care in the comfort of a patient’s own home, and with the right insurance can cost the patients nothing at all.

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Hospices have become big business for private equity firms, raising concerns about end-of-life care

Private Equity Hospice

Hospice care, once provided primarily by nonprofit agencies, has seen a remarkable shift over the past decade, with more than two-thirds of hospices nationwide now operating as for-profit entities. The ability to turn a quick profit in caring for people in their last days of life is attracting a new breed of hospice owners: private equity firms.

That rapid growth has many hospice veterans worried that the original hospice vision may be fading, as those capital investment companies’ demand for return on investment and the debt load they force hospices to bear are hurting patients and their families.

“Many of these transactions are driven by the motive of a quick profit,” said Dr. Joan Teno , an adjunct professor at Brown University School of Public Health, whose work has focused on end-of-life care. “I’m very concerned that you’re harming not only the dying patient, but the family whose memory will be of a loved one suffering because they didn’t get adequate care.”

According to a 2021 analysis , the number of hospice agencies owned by private equity firms soared from 106 in 2011 to 409 in 2019, out of a total of 5,615 hospices. Over that time, 72% of hospices acquired by private equity were nonprofits. And those trends have only accelerated into 2022.

Hospice is an easy business to start, with most care provided at home and using lower-cost health workers. That allowed the entry of smaller hospices, many launched with the intent of selling within a few years. Private equity firms, backed by deep-pocketed investors, could then snatch up handfuls of smaller hospices, cobble together a chain, and profit from economies of scale in administrative and supply costs, before selling to an even larger chain or another private equity firm.

Private equity-owned hospice companies counter that their model supports growth through investment, which benefits the people in their care.

“Private equity sees a huge opportunity to take smaller businesses that lack sophistication, lack the ability to grow, lack the capital investment, and private equity says, ‘We can come in there, cobble these things together, get standardization, get visibility and be able to create a better footprint, better access, and more opportunities,’” said Steve Larkin, CEO of Charter Healthcare , a hospice chain owned by the private equity firm Pharos Capital Group.

But he acknowledged that not all of those entering the hospice market have the best intentions.

“It is a little scary,” he said. “There are people that have no business being in health care” looking to invest in hospice.

A boom industry

With the U.S. population rapidly aging, hospice has become a boom industry. Medicare—the federal insurance program for people 65 and older, which pays for the vast majority of end-of-life care— spent $22.4 billion on hospice in 2020, according to a Medicare Payment Advisory Commission report to Congress. That’s up from $12.9 billion just a decade earlier. The number of hospices billing Medicare over that time grew from less than 3,500 to more than 5,000, according to the report.

But with limited oversight and generous payment, the industry is at high risk for exploitation. Agencies are paid a daily rate for each patient—this year, about $200—which encourages for-profit hospices to limit spending to boost their bottom lines. For-profit hospices tend to hire fewer employees than nonprofits and expect them to see more patients.

Many hospice nurses and social workers are booked for 30-minute appointment slots throughout the day, unable to spend more time with patients if needed. For-profit hospices hire more licensed practical nurses than registered nurses, who are more skilled, and rely more on nurse’s aides to further cut costs. One study found patients in for-profit hospices see doctors or nurse practitioners one-third as often as those in nonprofit hospices. The U.S. Government Accountability Office found in an analysis of federal data from 2014 to 2017 that patients in for-profit hospices were less likely than patients in nonprofit hospices to have received any hospice visits in the last three days of life.

“The main way of making the bottom line look good is decreasing visits,” Teno said.

According to the Medicare Payment Advisory Commission , for-profit hospices had Medicare profit margins of 19% in 2019, compared with 6% for nonprofit hospices.

For-profit hospices also enroll a different set of patients, preferring those likely to remain in hospice longer. Most costs are incurred in the first and last week of hospice care. Patients who enroll in hospice must undergo several assessments to develop a care plan and set their medications. In their final days, as the body begins to shut down, patients often need additional services or medications to stay comfortable.

“So the sweet spot is kind of in the middle,” said Robert Tyler Braun , an assistant professor of population health sciences at Weill Cornell Medical College.

That makes dementia patients particularly profitable. Doctors have a harder time predicting whether a patient with Alzheimer’s disease or another form of dementia has less than six months to live, the eligibility criterion for enrollment. For-profit hospices enroll those patients anyway, Teno said, and stand to profit the longer those patients live. They tend to enroll fewer cancer patients, whose prognosis is generally more predictable but who usually die sooner.

“It is a very simple business model,” Teno said. “Go to assisted living facilities and nursing homes, and it’s one-stop shopping.”

Nonprofit vs. For-Profit

The Rev. Ken Dugger has worked as a chaplain in Denver for 13 years at both for-profit and nonprofit hospices.

At one for-profit hospice, “the word on the street was [that] we were the dementia hospice because we had so many dementia patients,” Dugger said. “We wound up discharging a lot of patients because they had long lengths of stay and no longer met criteria.”

He said about a third of a hospice’s patients die each week, so agencies need to market heavily to replace them. That leads to some hospices making promises to families—such as daily visits from a nurse’s aide—that they can’t keep.

“Some people see dollars and they go, ‘Wow! It’s a great chance to make some money here,’ and they don’t understand that hospice isn’t easy,” Dugger said.

For-profit agencies counter that their nonprofit counterparts have cornered the market on cancer patients and that they are expanding access by serving patients with other diagnoses.

But if patients become too costly, requiring expensive care or medicines, hospice providers can discharge them, and take them to a hospital emergency room to get services the agencies don’t want to pay for themselves, said Christy Whitney , former CEO of HopeWest, a nonprofit hospice serving five western Colorado counties.

A 2019 report by the Milliman consulting firm found that 31% of patients in nonprofits had cancer, while 15% had dementia. At for-profit hospices, 22% of patients had cancer, and 22% had dementia, said the report, funded by the National Partnership of Hospice Innovation, a trade group of nonprofit hospices.

Patients in nonprofits had more nursing, social worker, and therapy visits. For-profit hospices, the report found, had longer lengths of stay by patients, discharged more patients before death, and had profit margins nearly seven times higher.

Other studies have found that for-profit hospices have higher rates of complaints and deficiencies, provide fewer community benefits, and have higher rates of emergency room and other hospital use.

Braun said financial pressures are worse for private equity-backed hospices than for other for-profit hospices, partly because of the way hospice acquisitions are financed. A private equity firm will typically put up only 10% to 30% of the acquisition cost itself, borrowing the rest. The acquired hospice not only has to generate profits to satisfy its private equity owners but is stuck with the costs of the loan as well.

Private equity firms typically look to flip their hospice investments in three to seven years.

In 2017, Webster Equity Partners bought Bristol Hospice, with 45 locations in 13 states, for $70 million. Last year, the firm reportedly entertained purchase offers for the hospice chain as high as $1 billion.

Because hospices are inspected every three years, some are bought and sold without a state or federal inspection—and sometimes without regulators even knowing about the sale.

And quality oversight is weak. Hospices have a financial interest in reporting quality metrics to the Centers for Medicare & Medicaid Services, but there is no penalty for poor performance tied to those metrics.

Cordt Kassner , CEO of the Colorado-based consulting firm National Hospice Analytics, said 17% of Colorado hospices are now owned by private equity, higher than the 13% rate he found nationally. When he looked at metrics reported to Medicare, he found that private equity-backed firms scored lower than average on self-reported quality metrics.

“It’s not a huge difference,” Kassner said. “Because nationally scores are also tight and there’s not a lot of variation, we look at any kind of difference even if it’s a percentage point less.”

Many nonprofits believe private equity-backed and other for-profit hospices are giving the industry a bad name.

“They get paid the same as us, but they don’t take the same patients. They don’t provide the covered services that are supposed to be covered to be paid a per diem,” said Whitney, the former HopeWest CEO, who spoke with KHN before she retired in June. “They’ve developed kind of a shadow business that really has very little to do with the business that I run. But they’re called the same name.”

Larkin, the Charter CEO, bemoaned a lack of progress in quality metrics as the hospice industry has grown. But he said that wasn’t limited to private equity-backed or even for-profit hospice providers.

“There’s bad companies all over,” Larkin said. “There’s people who are misaligned, there’s people who have bad intentions, there’s companies that aren’t focused on the right things.”

KHN (Kaiser Health News) is a national newsroom that produces in-depth journalism about health issues. Together with Policy Analysis and Polling, KHN is one of the three major operating programs at KFF (Kaiser Family Foundation). KFF is an endowed nonprofit organization providing information on health issues to the nation.

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hospice business model

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The business of hospice care, may 31, 2006 • 12 min listen.

Hospice care occupies a specialized and growing niche in the healthcare economy as a comfort to the dying and their families, and a potential cost-saver for Medicare. With baby boomers now hitting their seventh decade, hospice is expected to become an even more important part of the healthcare landscape, according to Wharton faculty and industry analysts. How profitable are hospice-providers, what is their long-term business outlook, and what are the unique challenges that hospice companies face, given strict government regulation amid increasing demand for their services?

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How to Start a Hospice Business

Hospice, also known as palliative care, offers clients a safe and caring environment as they prepare to pass on. Terminal patients are kept comfortable, receiving round the clock medical attention. Family members are offered support and education as they prepare for the passing of a loved one.

Learn how to start your own Hospice Business and whether it is the right fit for you.

Ready to form your LLC? Check out the Top LLC Formation Services .

Hospice Business Image

Start a hospice business by following these 10 steps:

  • Plan your Hospice Business
  • Form your Hospice Business into a Legal Entity
  • Register your Hospice Business for Taxes
  • Open a Business Bank Account & Credit Card
  • Set up Accounting for your Hospice Business
  • Get the Necessary Permits & Licenses for your Hospice Business
  • Get Hospice Business Insurance
  • Define your Hospice Business Brand
  • Create your Hospice Business Website
  • Set up your Business Phone System

We have put together this simple guide to starting your hospice business. These steps will ensure that your new business is well planned out, registered properly and legally compliant.

Exploring your options? Check out other small business ideas .

STEP 1: Plan your business

A clear plan is essential for success as an entrepreneur. It will help you map out the specifics of your business and discover some unknowns. A few important topics to consider are:

What will you name your business?

  • What are the startup and ongoing costs?
  • Who is your target market?

How much can you charge customers?

Luckily we have done a lot of this research for you.

Choosing the right name is important and challenging. If you don’t already have a name in mind, visit our How to Name a Business guide or get help brainstorming a name with our Hospice Business Name Generator

If you operate a sole proprietorship , you might want to operate under a business name other than your own name. Visit our DBA guide to learn more.

When registering a business name , we recommend researching your business name by checking:

  • Your state's business records
  • Federal and state trademark records
  • Social media platforms
  • Web domain availability .

It's very important to secure your domain name before someone else does.

Want some help naming your hospice business?

Business name generator, what are the costs involved in opening a hospice business.

Your start-up costs will vary depending upon the type of hospice care you with to provide and which state your business is located in. If your business plan includes opening a licensed home health non-Medicare facility, start-up costs are an estimated $60,000 to $100,000, while Medicare-certified hospice agencies should budget for $150,000 to $350,000.

Investments include:

  • Licensing for faculty and staff
  • Computer hardware and software
  • Commercial space for office and/or medical facility
  • Accreditation
  • Website, logo, business cards and other printable material
  • Marketing strategy and materials

Due to strict regulations, many looking to enter the hospice industry choose to invest in consulting services or a franchise . While this requires additional start-up capital, entrepreneurs receive guidance throughout the process. Profits are maximized, as time and resources are properly allocated from the moment the facility’s doors are opened.

What are the ongoing expenses for a hospice business?

In addition to the standard operational expenses, you’ll face a number of ongoing costs, ranging from $375,000 to $425,000 (and higher). Exact numbers vary, depending upon the size of your facility and specific services you offer. Payroll will consume the greatest portion of your budget, with fees and licenses coming in second. Business owners should also budget for travel and continuing education for employees, which will ensure the highest level of care for each patient.

Who is the target market?

Hospice care is reserved for terminally ill patients with a life expectancy of 6 months or less. If an individual lives beyond that timeframe, the medical director or physician must recertify that they are terminally ill.

How does a hospice business make money?

Both nonprofit and for-profit hospices receive funds from multiple sources. For many, charitable donations and grants comprise a great portion of their revenue. Additionally, they’re reimbursed by private insurance, Medicare, and Medicaid for each terminally ill patient they care for. Most facilities are reimbursed on a per diem basis, offering a set payment amount for each day the patient is enrolled in the program, regardless of services required. For patients who require around-the-clock home nursing care, hospice is reimbursed on an hourly basis.

Hospice facilities are reimbursed a daily rate for each patient, regardless of the level of services provided that day. Final payment amounts vary each year, but the average for routine care is approximately $146/day. If continuous care is necessary, Medicare reimburses at an hourly rate of approximately $40/hour.

How much profit can a hospice business make?

Successful hospice care business owners have reported $120,000 to $175,000 profit. Specifics vary depending upon: the number of patients your business cares for, the average billable hour rate for services provided, the number of hours each patient is provided each month. This figure, minus expenses and financing costs determines your total annual profit.

How can you make your business more profitable?

The following are a few strategies other hospice care business owners have implemented to ensure a more profitable business:

  • Identify underserved segments of the community and tailor to their needs.
  • Work with hospitals, physicians, and other facilities in the community to educate consumers on the benefits of hospice care. By creating awareness, you establish yourself as a leader in the industry and develop a strong referral base.
  • For those who would benefit, stress the importance of hospice care earlier in the disease process.
  • Develop a community outreach program.

Want a more guided approach? Access TRUiC's free Small Business Startup Guide - a step-by-step course for turning your business idea into reality. Get started today!

STEP 2: Form a legal entity

The most common business structure types are the sole proprietorship , partnership , limited liability company (LLC) , and corporation .

Establishing a legal business entity such as an LLC or corporation protects you from being held personally liable if your hospice business is sued.

Form Your LLC

Read our Guide to Form Your Own LLC

Have a Professional Service Form your LLC for You

Two such reliable services:

You can form an LLC yourself and pay only the minimal state LLC costs or hire one of the Best LLC Services for a small, additional fee.

Recommended: You will need to elect a registered agent for your LLC. LLC formation packages usually include a free year of registered agent services . You can choose to hire a registered agent or act as your own.

STEP 3: Register for taxes

You will need to register for a variety of state and federal taxes before you can open for business.

In order to register for taxes you will need to apply for an EIN. It's really easy and free!

You can acquire your EIN through the IRS website . If you would like to learn more about EINs, read our article, What is an EIN?

There are specific state taxes that might apply to your business. Learn more about state sales tax and franchise taxes in our state sales tax guides.

STEP 4: Open a business bank account & credit card

Using dedicated business banking and credit accounts is essential for personal asset protection.

When your personal and business accounts are mixed, your personal assets (your home, car, and other valuables) are at risk in the event your business is sued. In business law, this is referred to as piercing your corporate veil .

Open a business bank account

Besides being a requirement when applying for business loans, opening a business bank account:

  • Separates your personal assets from your company's assets, which is necessary for personal asset protection.
  • Makes accounting and tax filing easier.

Recommended: Read our Best Banks for Small Business review to find the best national bank or credit union.

Get a business credit card

Getting a business credit card helps you:

  • Separate personal and business expenses by putting your business' expenses all in one place.
  • Build your company's credit history , which can be useful to raise money later on.

Recommended: Apply for an easy approval business credit card from BILL and build your business credit quickly.

STEP 5: Set up business accounting

Recording your various expenses and sources of income is critical to understanding the financial performance of your business. Keeping accurate and detailed accounts also greatly simplifies your annual tax filing.

Make LLC accounting easy with our LLC Expenses Cheat Sheet.

STEP 6: Obtain necessary permits and licenses

Failure to acquire necessary permits and licenses can result in hefty fines, or even cause your business to be shut down.

Federal Business Licensing Requirements

To participate in Medicare, a hospice and must complete and submit an enrollment application . Hospices will be surveyed to determine if they meet federal requirements. Detailed information on the certification process can be found at the Centers for Medicare & Medicaid Services State Operations Manual .

State & Local Business Licensing Requirements

Each state has its own regulations regarding hospice care licensing. Check out your state’s information and make sure your hospice center is operating according to state law.

If you are serving food at your hospice center, you will likely need to pass a health inspection with your local health department. Here are some tips for faring well on a health inspection .

For more information about local licenses and permits:

  • Check with your town, city or county clerk’s office
  • Get assistance from one of the local associations listed in US Small Business Associations directory of local business resources

Most businesses are required to collect sales tax on the goods or services they provide. To learn more about how sales tax will affect your business, read our article, Sales Tax for Small Businesses .

Service Agreement

Hospice care businesses should consider requiring clients to sign a service agreement before starting a new project. This agreement should clarify client expectations and minimize risk of legal disputes by setting out payment terms and conditions, service level expectations, and intellectual property ownership. Here is an example service agreement.

Recommended: Rocket Lawyer makes it easy to create a professional service agreement for your hopsice care business when you sign up for their premium membership. For $39.95 per month, members receive access to hundreds of legal agreements and on call attorneys to get complimentary legal advice.

Certificate of Occupancy

Businesses operating out of a physical location typically require a Certificate of Occupancy (CO). A CO confirms that all building codes, zoning laws and government regulations have been met.

  • If you plan to lease a location:
  • It is generally the landlord’s responsibility to obtain a CO.
  • Before leasing, confirm that your landlord has or can obtain a valid CO that is applicable to a hospice business.
  • After a major renovation, a new CO often needs to be issued. If your place of business will be renovated before opening, it is recommended to include language in your lease agreement stating that lease payments will not commence until a valid CO is issued.
  • If you plan to purchase or build a location:
  • You will be responsible for obtaining a valid CO from a local government authority.
  • Review all building codes and zoning requirements for you business’ location to ensure your hospice business will be in compliance and able to obtain a CO.

STEP 7: Get business insurance

Just as with licenses and permits, your business needs insurance in order to operate safely and lawfully. Business Insurance protects your company’s financial wellbeing in the event of a covered loss.

There are several types of insurance policies created for different types of businesses with different risks. If you’re unsure of the types of risks that your business may face, begin with General Liability Insurance . This is the most common coverage that small businesses need, so it’s a great place to start for your business.

Another notable insurance policy that many businesses need is Workers’ Compensation Insurance . If your business will have employees, it’s a good chance that your state will require you to carry Workers' Compensation Coverage.

FInd out what types of insurance your Hospice Business needs and how much it will cost you by reading our guide Business Insurance for Hospice Business.

STEP 8: Define your brand

Your brand is what your company stands for, as well as how your business is perceived by the public. A strong brand will help your business stand out from competitors.

If you aren't feeling confident about designing your small business logo, then check out our Design Guides for Beginners , we'll give you helpful tips and advice for creating the best unique logo for your business.

Recommended : Get a logo using Truic's free logo Generator no email or sign up required, or use a Premium Logo Maker .

If you already have a logo, you can also add it to a QR code with our Free QR Code Generator . Choose from 13 QR code types to create a code for your business cards and publications, or to help spread awareness for your new website.

How to promote & market a hospice business

In addition to traditional marketing strategies such as advertisements in community newspapers and magazines, there are a number of things you can do to promote your business. Even in the face of death, knowledge provides power. Educate those within the community by maintaining an online presence and making guest appearances in local and national blogs/mailers.

Additionally, establish relationships with doctors, surgeons, hospitals, and post-operative clinics. Work with them to create educational seminars and pamphlets that will educate their patients on what they can expect to face next. These relationships within the medical community will provide a strong referral base.

How to keep customers coming back

Like many businesses, word of mouth is one of the most effective components of a marketing strategy. It’s important to keep in mind that current and prospective clients are facing the most difficult time in their lives. They’re struggling to say goodbye to family and friends, often while in pain. The best thing you can do for them is to educate and show compassion.

STEP 9: Create your business website

After defining your brand and creating your logo the next step is to create a website for your business .

While creating a website is an essential step, some may fear that it’s out of their reach because they don’t have any website-building experience. While this may have been a reasonable fear back in 2015, web technology has seen huge advancements in the past few years that makes the lives of small business owners much simpler.

Here are the main reasons why you shouldn’t delay building your website:

  • All legitimate businesses have websites - full stop. The size or industry of your business does not matter when it comes to getting your business online.
  • Social media accounts like Facebook pages or LinkedIn business profiles are not a replacement for a business website that you own.
  • Website builder tools like the GoDaddy Website Builder have made creating a basic website extremely simple. You don’t need to hire a web developer or designer to create a website that you can be proud of.

Recommended : Get started today using our recommended website builder or check out our review of the Best Website Builders .

Other popular website builders are: WordPress , WIX , Weebly , Squarespace , and Shopify .

STEP 10: Set up your business phone system

Getting a phone set up for your business is one of the best ways to help keep your personal life and business life separate and private. That’s not the only benefit; it also helps you make your business more automated, gives your business legitimacy, and makes it easier for potential customers to find and contact you.

There are many services available to entrepreneurs who want to set up a business phone system. We’ve reviewed the top companies and rated them based on price, features, and ease of use. Check out our review of the Best Business Phone Systems 2023 to find the best phone service for your small business.

Recommended Business Phone Service: Phone.com

Phone.com is our top choice for small business phone numbers because of all the features it offers for small businesses and it's fair pricing.

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Is this Business Right For You?

This business is best suited for individuals who are passionate about helping others and can offer compassion and understanding to their clients. Additionally, owning a palliative care facility requires a leader who is ready to face the challenges that come with running a multi-faceted facility, meeting the needs of employees spanning several departments.

Want to know if you are cut out to be an entrepreneur?

Take our Entrepreneurship Quiz to find out!

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What happens during a typical day at a hospice business?

Your day-to-day activities will vary, depending upon how large of a role you wish to take within the organization. Initially, many palliative care facility owners serve as the hospice administrator, which requires them to wear many hats. Their typical duties include:

  • Answering emails and phone calls from prospective clients/patients
  • Meeting with prospective clients/patients to identify their needs
  • Keeping up with local, state, regional, and national regulations to ensure the facility is in compliance
  • Identifying organizational policies that require updating and implement changes
  • Budget management
  • Maintaining relationships with vendors, medical professionals, and support staff
  • Fundraising
  • Overseeing the recruitment, hiring, training, and supervision of workforce

As the business expands, you’ll want to employ team members to take over many of the above duties, as well as the day-to-day administrative duties you’ll initially be tasked with.

What are some skills and experiences that will help you build a successful hospice business?

While not required, experience in the healthcare industry would prove beneficial. If you’re lacking this experience, hire an administrator that can offer their expertise in operating a medical facility of this magnitude.

Given the sensitive nature of the business, it’s critical that one possess strong interpersonal skills. Aside from patients and family members, you must be able to effectively communicate with staff, pharmacists, healthcare professionals, religious clergy, and funeral directors. Additional skills that would prove beneficial are:

  • Critical thinking - Must be able to identify strengths and weaknesses in your business’ care programs.
  • Problem solving and decision-making, particularly under pressure
  • Time management
  • Organizational
  • Compassion and empathy

What is the growth potential for a hospice business?

Due to changes in patient needs and preferences and an increasingly aging population, the hospice industry has grown to almost $19 billion over the last decade. It’s projected to grow another 7.4% annually through 2017. Through strong marketing campaigns and cost-saving initiatives, many hospice founders report aggressive growth, beginning their first year of business. Dedicated and innovative entrepreneurs have a unique opportunity to participate in a profession with virtually unlimited growth potential.

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Take the Next Step

Find a business mentor.

One of the greatest resources an entrepreneur can have is quality mentorship. As you start planning your business, connect with a free business resource near you to get the help you need.

Having a support network in place to turn to during tough times is a major factor of success for new business owners.

Learn from other business owners

Want to learn more about starting a business from entrepreneurs themselves? Visit Startup Savant’s startup founder series to gain entrepreneurial insights, lessons, and advice from founders themselves.

Resources to Help Women in Business

There are many resources out there specifically for women entrepreneurs. We’ve gathered necessary and useful information to help you succeed both professionally and personally:

If you’re a woman looking for some guidance in entrepreneurship, check out this great new series Women in Business created by the women of our partner Startup Savant.

What are some insider tips for jump starting a hospice business?

The following are some tips from successful hospice professionals:

  • To realize long-term success, you maintain a commitment to networking within the medical and religious community.
  • Proper program planning is critical from Day 1.
  • Carefully choose your Board of Directors to include the talent and experience required to run a successful program.
  • Make sure you staff your facility with caring, knowledgeable employees and volunteers.
  • Avoid competition between other hospice providers in your area. Instead, work with them to clearly define and highlight each facility’s strength in services and educate the public.

How and when to build a team

Your hospice care business will require an experienced team from the onset. Your team will consist of volunteers, nurses, physicians, billing, human resources, and administrative staff. Each team member must maintain a high level of professionalism and maturity at all times, so it is critical that you choose your staff wisely.

Read our hospice business hiring guide to learn about the different roles a hospice business typically fills, how much to budget for employee salaries, and how to build your team exactly how you want it.

Useful Links

Truic resources.

  • TRUiC's Hospice Business Hiring Guide

Industry Opportunities

  • Hospice Consulting Services
  • National Association for Home Care and Hospice
  • National Hospice and Palliative Care Association

Real World Examples

  • Experience of O.C. Hospice
  • Michigan-based hospice
  • NYC-based hospice

Further Reading

  • Guidelines and suggestions for getting started
  • Information on hospice industry
  • Hospice business plan

Have a Question? Leave a Comment!


Starting a Successful Hospice Business – Part I

Successful Hospice Business

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Table of Contents

Successful hospice business is a process where clients can find a caring environment and quality of life at the end of their days as they prepare themselves to pass on. These terminal patients are cared for in the best way possible and kept comfortable. They receive medical care round the clock from the hospice while their family members are also given support and updates about their loved ones.Starting a Hospice business can be a tricky one because there are regulations that need to be fulfilled. It is more than just registering your hospice business with the government. We at Hucu.ai have compiled the essential steps that can ensure your new hospice business is well planned, registered properly, legally sound, and becomes successful.Step 1: Planning the business correctlyAn organized, clear plan is needed for a successful hospice business. It helps to map out the specifics of the business. Here are the important questions one needs to ask before opening a hospice business.

What are the major costs?

A hospice startup cost will be different depending on the type of hospice one is opening and which state it is located in. The main cost can range from $70,000 to $120,000 if it is a non-Medicare facility. If it is a Medicare-certified hospice agency the cost can range from $160,000 to $400,000. These costs include licensing for faculty and staff, computer hardware and software, physical space for the facility, accreditation, business branding, marketing materials, inventory, and insurance. Since the regulations are strict, many entrepreneurs may choose to invest in consultation services which increase the costs while increasing confidence in compliance.

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What are the ongoing costs?

Apart from the standard operational expenses, there will be ongoing annual costs ranging between $400,000 to $450,000 (on the higher side). Exact numbers will differ depending on the size of the facility and the number of services being offered. Payroll will take up the greatest portion of the ongoing costs.

How will the hospice business make money?

Successful Hospice Business

How much profit can be made?

The average payment reimbursed to hospice facilities by Medicare ranges from $145/day or at an hourly rate of $40/hour if care is being given 24/7. Given this, successful hospice businesses have shown to make up to $120,000 to $200,000 in profits annually. Of course, the amount will vary depending on the number of patients, number of services offered, and ongoing expenses.

How can the business profits be optimized?

Successful hospice businesses use several strategies to ensure optimization of their profits. These include finding a gap in the market, taking up underserved segments of the market, and customizing services to their needs. Another strategy is to work with physicians, hospitals and other facilities in the community and highlight the benefits of using hospice facilities. This will develop a strong referral base.Step 2: Forming a Legal Corporate Entity and Registering for TaxesThe three most common types of legal entities are sole proprietorship, partnership, Limited Liability Company, and C corporation. If the business owner wants to be protected from being personally liable, he can opt for an LLC or a corporation.Once the business owner has decided on the legal entity, the business must be registered for each state in which services are provided as well as for federal taxes before officially opening the business. The business owner will need an EIN to do that. If the business structure is an LLC, it can benefit from being taxed as an S Corp . there may be specific state taxes applied to a hospice business. Here are the details on starting an LLC.

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Here is How Step 3: Getting a Bank Account, Credit Card, and Setting Up Business AccountingIf the business owner wants personal asset protection, then dedicated business banking and credit accounts are needed. It is important to keep personal accounts separate from business accounts. It makes taxing and filing easier too.Once that is done, the hospice business owner needs to set up business accounting to record various expenses and sources of income in order to understand the financial performance of the hospice facility.Step 4: Getting Permits and LicensesIf a hospice business does not have the essential permits and licenses, it can result in heavy fines and shutting down the business altogether. The federal business licensing requirements call for a hospice to complete and submit an enrollment application . Once done, the hospice will be checked out to see if it meets the federal requirements.State and local business licensing requirements are different as each state has its regulations regarding hospice care licensing. This guide will help in determining if the hospice is operating according to the correct state law.Hospice facilities that are working out of a physical location also need a certificate of occupancy (CO). The CO confirms that all working areas, building codes, zoning laws, and government regulations are being met.Check out the remaining steps in part II of this guide. Source of information: howtostartanllc.com , ankota.com , certifiedhomecareconsulting.com Get Ready To Transform Your Organization For Value Based Care.

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Hospice Care Business Model Canvas

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Resources On Hospice Care

  • Financial Model
  • Business Plan
  • Value Proposition
  • One-Page Business Plan
  • SWOT Analysis
  • Description
  • 1. Key Partnerships
  • 2. Key Activities
  • 3. Key Resources
  • 4. Value Propositions
  • 5. Customer Relationships
  • 6. Channels
  • 7. Customer Segments
  • 8. Cost Structure
  • 9. Revenue Streams


With growing longevity in developed countries, palliative care services have become increasingly important for those facing terminal illnesses. Hospice care is a form of palliative care and is currently seeing tremendous growth. According to The National Hospice and Palliative Care Organization, in 2018, the number of hospice patients grew to 1.49 million in the United States, which is a record-breaking number. In the same year, hospice care spending grew by 9.2 percent from 2017, totaling $18.2 billion.

Hospice care can not only improve end of life care but also support families and caregivers of those that are facing serious illnesses. These services are often utilized to help keep patients at home with family. Hospice care can provide psychological, spiritual, and physical comfort, while providing family and caregivers support.

This blog post will discuss the benefits of hospice care, the services they provide, common misconceptions, and the need for comprehensive hospice care.

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Key Partnerships

In order to efficiently provide hospice services and ensure a high quality of care, partnerships with various local providers and related firms are essential. Partnerships in this area include, but are not limited to:

  • Local doctors and medical providers - critical relationships for providing medical attention, diagnosis, and direction for end of life care.
  • Local hospitals and health care facilities - for providing access to specialists and medications.
  • Mortuary services - for processing and disposing of the remains of those in hospice.
  • Legal, financial, and logistics providers - for providing sound advice and assistance in the accumulation and care of estates following death.

Key Activities

Hospice care is a specialized form of care designed to help people with a terminal illness achieve the best quality of life possible. The key activities of hospice care include:

  • Providing Compassion : Offering emotional, physical, and spiritual support to the patient and their family.
  • Providing Counseling and Comfort : Helping the patient and their family adjust to their changing circumstances, and providing comfort at end of life.
  • Providing Medical and Nutrition Support : Working with the patient and their family to develop a plan of care that focuses on the patient's quality of life.
  • Coaching Family and Friends : Offering guidance and support for those paying for care, as well as educating them on how to support the patient through their illness and end of life experience.
  • Helping with Legal, Financial and Logistical Matters : Assisting the patient and their family with legal, financial, and logistical matters related to the patient's health condition.
  • Gathering Resources : Locating and making available specialized resources and services to the patient and their family.
  • Researching and Organizing Hospice Care : Exploring and organizing treatments, services, and facilities to provide the best hospice care for the patient.

Key Resources

When building a hospice care business model canvas, key resources include:

  • Hospice care facility - This is the tangible physical location of the hospice care facility, including the structure itself and its content.
  • Volunteers and staff - A hospice care business model canvas will require a team of dedicated volunteers and staff in order to carry out its operations.
  • Medical and nutrition resources - As a hospice care business model, specialized medical equipment and nutrition supplies are essential for providing quality care.
  • Legal and financial resources - In order to comply with existing laws and regulations, a hospice care business model canvas will require a source of legal and financial resources.
  • Technical and research resources - To stay up-to-date with the latest changes within the industry, the business plan requires access to technical and research resources.

Value Propositions

  • Compassionate and professional care from volunteers and staff
  • Personalized care tailored to individual needs
  • Assistance with logistics, legal, and financial issues
  • Help accessing necessary medical, nutritional, and other resources
  • Create meaningful and lasting moments

Customer Relationships

Hospice Care is committed to providing its customers with high quality and specialized care. In order to meet this commitment, we will be offering the following services:

  • In-person care at the hospice care facility
  • Telephone and video conference consultations
  • Remote coaching services in legal, financial, and logistics
  • Access to specialized problem-solving resources

In order to ensure that our customers receive the best possible care, we will use a personalized approach to ensure that each customer's unique needs are met.

Hospice care's channels include:

  • Direct marketing with local healthcare providers
  • Online website, social media, and other digital platforms
  • Referral from hospitals, doctors, and mortuary services

Direct marketing with local healthcare providers: This includes creating relationships with hospitals, doctors, nursing homes and other specialist care services to promote hospice care and reach out to those in need.

Online website, social media, and digital platforms: Hospice care should strive to create an online presence through a website and various social media platforms to promote their services and reach potential customers.

Referral from hospitals, doctors, and mortuary services: Hospice care should also seek referral opportunities from hospitals, doctors, and mortuary services to reach patients who may benefit from their services.

Customer Segments

The customer segments of a hospice care include individuals facing terminal physical and emotional challenges, their family members and loved ones, legal, financial and logistics providers.

Cost Structure

The costs structures associated with Hospice Care involve personnel costs, facility costs, research and technical tools, and marketing costs.

  • Wages of contract workers
  • Training and professional development costs
  • Insurance costs
  • Lease costs
  • Maintenance and repair costs
  • Furniture and fixtures
  • Software and other digital tools
  • Equipment and devices
  • Books and data collection expenses
  • Advertising
  • Public relations
  • Website design and maintenance charges

Revenue Streams

Hospice care provides end-of-life care and services, and has several potential revenue streams, which are outlined below:

  • Payment from individuals: Invoices for services delivered can be sent to individuals for payment.
  • Insurance plans: Patients can be billed under their insurance plans, with the hospice receiving the payment from the insurance provider.
  • Government and private grants: Non-profit hospices can obtain grants from governments and private organizations to fund their operations.
  • Donations: Donors may provide monetary donations, which can be used to provide services or purchase equipment.

The Business Model Canvas for a Hospice Care provides a comprehensive framework for launching, growing, and operating a successful hospice care business efficiently, economically, and professionally. It combines strategic insight, financial planning, service delivery, and project management information into an actionable and comprehensive plan. By carefully constructing the Business Model Canvas, the hospice care provider will be able to deploy the right type of care, find and track the right resources, maintain a profitable and organized practice, and deliver quality care to its clients.

The Business Model Canvas for a Hospice Care provides a roadmap to streamline and optimize a hospice operation. It defines the components of a successful organization, outlines strategies for successful operation, and identifies realistic goals and benchmarks for measurement. By taking a holistic approach to hospice care, the Business Model Canvas can help the hospice provider to maximize the quality of their service, reach and engage the right clients, and deliver the best possible care for their patients and families.

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How Hospice Became a For-Profit Hustle

By Ava Kofman

A hospice room wrapped in the middle of string tied by 2 large hands.

Over the years, Marsha Farmer had learned what to look for. As she drove the back roads of rural Alabama, she kept an eye out for dilapidated homes and trailers with wheelchair ramps. Some days, she’d ride the one-car ferry across the river to Lower Peach Tree and other secluded hamlets where a few houses lacked running water and bare soil was visible beneath the floorboards. Other times, she’d scan church prayer lists for the names of families with ailing members.

Farmer was selling hospice, which, strictly speaking, is for the dying. To qualify, patients must agree to forgo curative care and be certified by doctors as having less than six months to live. But at AseraCare, a national chain where Farmer worked, she solicited recruits regardless of whether they were near death. She canvassed birthday parties at housing projects and went door to door promoting the program to loggers and textile workers. She sent colleagues to cadge rides on the Meals on Wheels van or to chat up veterans at the American Legion bar. “We’d find run-down places where people were more on the poverty line,” she told me. “You’re looking for uneducated people, if you will, because you’re able to provide something to them and meet a need.”

Farmer, who has doe eyes and a nonchalant smile, often wore scrubs on her sales routes, despite not having a medical background. That way, she said, “I would automatically be seen as a help.” She tried not to mention death in her opening pitch, or even hospice if she could avoid it. Instead, she described an amazing government benefit that offered medications, nursing visits, nutritional supplements, and light housekeeping—all for free. “Why not try us just for a few days?” she’d ask families, glancing down at her watch as she’d been trained to do, to pressure them into a quick decision.

This article is a collaboration between The New Yorker and ProPublica.

Once a prospective patient expressed interest, a nurse would assess whether any of the person’s conditions fit—or could be made to fit—a fatal prognosis. The Black Belt, a swath of the Deep South that includes parts of Alabama, has some of the highest rates of heart disease, diabetes, and emphysema in the country. On paper, Farmer knew, it was possible to finesse chronic symptoms, like shortness of breath, into proof of terminal decline.

When Farmer started out in the hospice business, in 2002, it felt less like a sales gig than like a calling. At thirty, she’d become a “community educator,” or marketer, at Hospice South, a regional chain that had an office in her home town, Monroeville, Alabama. Monroeville was the kind of place where, if someone went into hospice, word got around and people sent baked goods. She often asked patients to write cards or make tape recordings for milestones—birthdays, anniversaries, weddings—that they might not live to see. She became an employee of the month and, within a year, was promoted to executive director of the branch, training a staff of her own to evangelize for end-of-life care.

Things began to change in 2004, when Hospice South was bought by Beverly Enterprises, the second-largest nursing-home chain in the country, and got folded into one of its subsidiaries, AseraCare. Not long before the sale, Beverly had agreed to pay a five-million-dollar criminal fine and a hundred-and-seventy-five-million-dollar civil settlement after being accused of Medicare fraud. Its stock value had slumped, and Beverly’s C.E.O. had decided that expanding its empire of hospices would help the company attract steadier revenue in “high-growth, high-margin areas of healthcare services.” Less than two years later, as part of a wave of consolidations in the long-term-care industry, Beverly was sold to a private-equity firm, which rebranded it as Golden Living.

It might be counterintuitive to run an enterprise that is wholly dependent on clients who aren’t long for this world, but companies in the hospice business can expect some of the biggest returns for the least amount of effort of any sector in American health care. Medicare pays providers a set rate per patient per day, regardless of how much help they deliver. Since most hospice care takes place at home and nurses aren’t required to visit more than twice a month, it’s not difficult to keep overhead low and to outsource the bulk of the labor to unpaid family members—assuming that willing family members are at hand.

Three waiters standing in the middle of crowded restaurant.

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Up to a point, the way Medicare has designed the hospice benefit rewards providers for recruiting patients who aren’t imminently dying. Long hospice stays translate into larger margins, and stable patients require fewer expensive medications and supplies than those in the final throes of illness. Although two doctors must initially certify that a patient is terminally ill, she can be recertified as such again and again.

Almost immediately after the Asera-Care takeover, Farmer’s supervisors set steep targets for the number of patients marketers had to sign up, and presented those who met admissions quotas with cash bonuses and perks, including popcorn machines and massage chairs. Employees who couldn’t hit their numbers were fired. Farmer prided herself on being competitive and liked to say, “I can sell ice to an Eskimo.” But as her remit expanded to include the management of AseraCare outposts in Foley and Mobile, she began to resent the demand to bring in more bodies. Before one meeting with her supervisor, Jeff Boling, she stayed up late crunching data on car wrecks, cancer, and heart disease to figure out how many people in her territories might be expected to die that year. When she showed Boling that the numbers didn’t match what she called his “ungodly quotas,” he was unmoved. “If you can’t do it,” she recalled him telling her, “we’ll find someone who can.”

Farmer’s bigger problem was that her patients weren’t dying fast enough. Some fished, drove tractors, and babysat grandchildren. Their longevity prompted concern around the office because of a complicated formula that governs the Medicare benefit. The federal government, recognizing that an individual patient might not die within the predicted six months, effectively demands repayment from hospices when the average length of stay of all patients exceeds six months.

But Farmer’s company, like many of its competitors, had found ways to game the system and keep its money. One tactic was to “dump,” or discharge, patients with overly long stays. The industry euphemism is “graduated” from hospice, though the patient experience is often more akin to getting expelled: losing diapers, pain medications, wheelchairs, nursing care, and a hospital-grade bed that a person might not otherwise be able to afford. In 2007, according to Farmer’s calculations around the time, seventy per cent of the patients served by her Mobile office left hospice alive.

Another way to hold on to Medicare money was to consistently pad the roster with new patients. One day in 2008, facing the possibility of a repayment, AseraCare asked some of its executive directors to “get double digit admits” and to “have the kind of day that will go down in the record books.” A follow-up e-mail, just an hour later, urged staff to “go around the barriers and make this happen now, your families need you.”

That summer, Boling pushed Farmer to lobby oncologists to turn over their “last breath” patients: those with only weeks or days to live. At the time, Farmer’s fifty-nine-year-old mother was dying of metastatic colon cancer. Although Farmer knew that the service might do those last-breath people good, it enraged her that her hospice was chasing them cynically, to balance its books. The pressure was so relentless that sometimes she felt like choking someone, but she had two small children and couldn’t quit. Her husband, who had been a co-worker at AseraCare, had already done so. Earlier that year, after fights with Boling and other supervisors about quotas, he had left for a lower-paying job, at Verizon.

Farmer’s confidante at work, Dawn Richardson, shared her frustration. A gifted nurse who was, as Farmer put it, “as country as a turnip,” Richardson hated admitting people who weren’t appropriate or dumping patients who were. She was a single mom, though, and needed a paycheck. One evening in early 2009, the two happened upon another way out.

The local news was reporting that two nurses at SouthernCare, a prominent Alabama-based competitor, had accused the company of stealing taxpayer dollars by enrolling ineligible patients in hospice. SouthernCare, which admitted no wrongdoing, settled with the Justice Department for nearly twenty-five million dollars, and the nurses, as whistle-blowers, had received a share of the sum—$4.9 million, to be exact. Farmer and Richardson had long felt uneasy about what AseraCare asked them to do. Now, they realized, what they were doing might be illegal. They decided to call James Barger, a lawyer who had represented one of the SouthernCare nurses. That March, he helped Farmer and Richardson file a whistle-blower complaint against AseraCare and Golden Living in the Northern District of Alabama, accusing the company of Medicare fraud. The case would go on to become the most consequential lawsuit the hospice industry had ever faced.

The philosophy of hospice was imported to the United States in the nineteen-sixties by Dame Cicely Saunders, an English doctor and social worker who’d grown appalled by the “wretched habits of big, busy hospitals where everyone tiptoes past the bed and the dying soon learn to pretend to be asleep.” Her counter-practice, which she refined at a Catholic clinic for the poor in East London, was to treat a dying patient’s “total pain”—his physical suffering, spiritual needs, and existential disquiet. In a pilot program, Saunders prescribed terminally ill patients cocktails of morphine, cocaine, and alcohol—whiskey, gin, or brandy, depending on which they preferred. Early results were striking. Before-and-after photos of cancer patients showed formerly anguished figures knitting scarves and raising toasts.

Saunders’s vision went mainstream in 1969, when the Swiss-born psychiatrist Elisabeth Kübler-Ross published her groundbreaking study, “On Death and Dying.” The subjects in her account were living their final days in a Chicago hospital, and some of them described how lonely and harsh it felt to be in an intensive-care unit, separated from family. Many Americans came away from the book convinced that end-of-life care in hospitals was inhumane. Kübler-Ross and Saunders, like their contemporaries in the women’s-health and deinstitutionalization movements, pushed for greater patient autonomy—in this case, for people to have more control over how they would exit the world. The first American hospice opened in Connecticut, in 1974. By 1981, hundreds more hospices had started, and, soon after, President Ronald Reagan recognized the potential federal savings—many people undergo unnecessary, expensive hospitalizations just before they die—and authorized Medicare to cover the cost.

Forty years on, half of all Americans die in hospice care. Most of these deaths take place at home. When done right, the program allows people to experience as little pain as possible and to spend meaningful time with their loved ones. Nurses stop by to manage symptoms. Aides assist with bathing, medications, and housekeeping. Social workers help families over bureaucratic hurdles. Clergy offer what comfort they can, and bereavement counsellors provide support in the aftermath. This year, I spoke about hospice with more than a hundred and fifty patients, families, hospice employees, regulators, attorneys, fraud investigators, and end-of-life researchers, and all of them praised its vital mission. But many were concerned about how easy money and a lack of regulation had given rise to an industry rife with exploitation. In the decades since Saunders and her followers spread her radical concept across the country, hospice has evolved from a constellation of charities, mostly reliant on volunteers, into a twenty-two-billion-dollar juggernaut funded almost entirely by taxpayers.

For-profit providers made up thirty per cent of the field at the start of this century. Today, they represent more than seventy per cent, and between 2011 and 2019, research shows, the number of hospices owned by private-equity firms tripled. The aggregate Medicare margins of for-profit providers are three times that of their nonprofit counterparts. Under the daily-payment structure, a small hospice that bills for just twenty patients at the basic rate can take in more than a million dollars a year. A large hospice billing for thousands of patients can take in hundreds of millions. Those federal payments are distributed in what is essentially an honor system. Although the government occasionally requests more information from billers, it generally trusts that providers will submit accurate claims for payment—a model that critics deride as “pay and chase.”

Jean Stone, who worked for years as a program-integrity senior specialist at the Centers for Medicare and Medicaid Services, said that hospice was a particularly thorny sector to police, for three reasons: “No one wants to be seen as limiting an important service”; it’s difficult to retrospectively judge a patient’s eligibility; and “no one wants to talk about the end of life.” Although a quarter of all people in hospice enter it only in their final five days, most of the Medicare spending on hospice is for patients whose stays exceed six months. In 2018, the Office of Inspector General at the Department of Health and Human Services estimated that inappropriate billing by hospice providers had cost taxpayers “hundreds of millions of dollars.” Stone and others I spoke to believe the figure to be far higher.

Some hospice firms bribe physicians to bring them new patients by offering all-expenses-paid trips to Las Vegas night clubs, complete with bottle service and private security details. (The former mayor of Rio Bravo, Texas, who was also a doctor, received outright kickbacks.) Other audacious for-profit players enlist family and friends to act as make-believe clients, lure addicts with the promise of free painkillers, dupe people into the program by claiming that it’s free home health care, or steal personal information to enroll “phantom patients.” A twenty-nine-year-old pregnant woman learned that she’d been enrolled in Revelation Hospice, in the Mississippi Delta (which at one time discharged ninety-three per cent of its patients alive), only when she visited her doctor for a blood test. In Frisco, Texas, according to the F.B.I., a hospice owner tried to evade the Medicare-repayment problem by instructing staff to overdose patients who were staying on the service too long. He texted a nurse about one patient, “He better not make it tomorrow. Or I will blame u.” The owner was sentenced to more than thirteen years in prison for fraud, in a plea deal that made no allegations about patient deaths.

Man opens up bag of mice at pool table.

A medical background is not required to enter the business. I’ve come across hospices owned by accountants; vacation-rental superhosts; a criminal-defense attorney who represented a hospice employee convicted of fraud and was later investigated for hospice fraud himself; and a man convicted of drug distribution who went on to fraudulently bill Medicare more than five million dollars for an end-of-life-care business that involved handling large quantities of narcotics.

Once a hospice is up and running, oversight is scarce. Regulations require surveyors to inspect hospice operations once every three years, even though complaints about quality of care are widespread. A government review of inspection reports from 2012 to 2016 found that the majority of all hospices had serious deficiencies, such as failures to train staff, manage pain, and treat bedsores. Still, regulators rarely punish bad actors. Between 2014 and 2017, according to the Government Accountability Office, only nineteen of the more than four thousand U.S. hospices were cut off from Medicare funding.

Because patients who enroll in the service forgo curative care, hospice may harm patients who aren’t actually dying. Sandy Morales, who until recently was a case manager at the California Senior Medicare Patrol hotline, told me about a cancer patient who’d lost access to his chemotherapy treatment after being put in hospice without his knowledge. Other unwitting recruits were denied kidney dialysis, mammograms, coverage for life-saving medications, or a place on the waiting list for a liver transplant. In response to concerns from families, Morales and her community partners recently posted warnings in Spanish and English in senior apartment buildings, libraries, and doughnut shops across the state. “Have you suddenly lost access to your doctor?” the notices read. “Can’t get your medications at the pharmacy? Beware! You may have been tricked into signing up for a program that is medically unnecessary for you.”

Some providers capitalize on the fact that most hospice care takes place behind closed doors, and that those who might protest poor treatment are often too sick or stressed to do so. One way of increasing company returns is to ghost the dying. A 2016 study in JAMA Internal Medicine of more than six hundred thousand patients found that twelve per cent received no visits from hospice workers in the last two days of life. (Patients who died on a Sunday had some of the worst luck.) For-profit hospices have been found to have higher rates of no-shows and substantiated complaints than their nonprofit counterparts, and to disproportionately discharge patients alive when they approach Medicare’s reimbursement limit.

“There are so many ways to do fraud, so why pick this one?” Stone said. This was more or less what Marsha Farmer and Dawn Richardson had been wondering when they filed their complaint against AseraCare in 2009. Now, working undercover, they imagined themselves as part of the solution.

In the absence of guardrails, whistle-blowers like Farmer and Richardson have become the government’s primary defense against hospice wrongdoing—an arrangement that James Barger, their lawyer, describes as placing “a ludicrous amount of optimism in a system with a capitalist payee and a socialist payer.” Seven out of ten of the largest hospices in the U.S. have been sued at least once by former employees under the federal False Claims Act. The law includes a “qui tam” provision—the term derives from a Latin phrase that translates as “he who sues on behalf of the King as well as himself”—that deputizes private citizens to bring lawsuits that accuse government contractors of fraud and lets them share in any money recovered. Qui-tam complaints, like Farmer and Richardson’s, are initially filed secretly, under seal, to give the Justice Department a chance to investigate a target without exposing the tipster. If the government decides to proceed, it takes over the litigation. In 2021 alone, the government recovered more than $1.6 billion from qui-tam lawsuits, and the total amount awarded to whistle-blowers was two hundred and thirty-seven million dollars.

In the two years after Farmer and Richardson filed their complaint, both slept poorly. But their covert undertaking also felt cathartic—mental indemnification against a job that troubled their consciences. Farmer continued to bring in patients at AseraCare while passing company documents to Barger, including spreadsheets analyzing admissions quotas and a training PowerPoint used by the company’s national medical adviser, Dr. James Avery. A pulmonologist who was fond of citing Seneca, Tolstoy, and Primo Levi in his slides, Avery urged nurses to “be a detective” and to “look for clues” if a patient didn’t initially appear to fit a common hospice diagnosis. (Avery said that he never encouraged employees to admit ineligible patients.) He sometimes concluded his lectures with a spin on an idea from Goethe’s “Faust”: “Perpetual striving that has no goal but only progress or increase is a horror.”

Barger was impressed by the records that Farmer collected and even more so by her candor about her involvement in AseraCare’s schemes. She and Richardson reminded him of friends he’d had growing up: smart, always finishing each other’s sentences, and not, he said, “trying to be heroes.” Nor, as it turned out, were they the only AseraCare employees raising questions about company ethics. The year before, three nurses in the Milwaukee office had filed a qui-tam complaint outlining similar corporate practices. The False Claims Act has a “first to file” rule, so the Wisconsin nurses could have tried to block Farmer and Richardson from proceeding with their case. Instead, the nurses decided to team up with their Alabama colleagues, even if it meant that they’d each receive a smaller share of the potential recovery. Also joining the crew was Dr. Joseph Micca, a former medical director at an AseraCare hospice in Atlanta. Every hospice is required to hire or contract with a doctor to sign forms certifying a patient’s eligibility for the program, and Micca accused the company of both ineligible enrollments and lapses in patient care. In his deposition, he described one patient who was given morphine against his orders and was kept in hospice care for months after she’d recovered from a heart attack. The woman, who was eventually discharged, lived several more years.

Among the most critical pieces of evidence to emerge in the discovery process was an audit that echoed many of the allegations made by the whistle-blowers. In 2007 and 2008, AseraCare had hired the Corridor Group, a consulting firm, to visit nine of its agencies across the country, including the Monroeville office that Farmer oversaw. The Corridor auditors observed a “lack of focus” on patient care and “little discussion of eligibility” at regular patient-certification meetings. Clinical staff were undertrained, with a “high potential for care delivery failures,” and appeared reluctant to discharge inappropriate patients, out of fear of being fired. E-mails showed that the problems raised by the audit were much discussed among AseraCare’s top leadership, including its vice-president of clinical operations, Angie Hollis-Sells.

One morning in the spring of 2011, Hollis-Sells strode into the old bank building that housed the Monroeville office, her expression uncommonly stern. Farmer knew at once that her role in the case had been exposed. She was sent home on paid leave, and that evening half a dozen colleagues showed up at her clapboard house, in the center of town. Some felt betrayed. Their manager had kept from them a secret that might upend their livelihoods; worse, her accusations seemed to condemn them for work she’d asked them to do. But shortly afterward, when Farmer took a job as the executive director of a new hospice company in Monroeville, Richardson and several other former co-workers joined her.

Less than a year later, the Justice Department, after conducting its own investigation, intervened in the whistle-blowers’ complaint, eventually seeking from AseraCare a record two hundred million dollars in fines and damages. As Barger informed his clients, the company was likely to settle. Most False Claims Act cases never reach a jury, in part because trials can cost more than fines and carry with them the threat of exclusion from the Medicare program—an outcome tantamount to bankruptcy for many medical providers. In 2014, Farmer travelled to Birmingham for her deposition, imagining that the case would soon end. But, in the first of a series of unexpected events, AseraCare decided to fight.

United States v. AseraCare, which began on August 10, 2015, in a federal courthouse in Birmingham, was one of the most bizarre trials in the history of the False Claims Act. To build its case against AseraCare, the government had identified some twenty-one hundred of the company’s patients who had been in hospice for at least a year between 2007 and 2011. From that pool, a palliative-care expert, Dr. Solomon Liao, of the University of California, Irvine, reviewed the records of a random sample of two hundred and thirty-three patients. He found that around half of the patients in the sample were ineligible for some or all of the hospice care they’d received. He also concluded that ineligible AseraCare patients who had treatable or reversible issues at the root of their decline were unable to get the care they needed, and that being in hospice “worsened or impeded the opportunity to improve their quality of life.”

Before the trial started, the judge in the case, Karon O. Bowdre, disclosed that she’d had good experiences with hospice. Her mother, who had an A.L.S. diagnosis, had spent a year and a half on the service, and her father-in-law had died in hospice shortly before the trial. Principals in the case disagree about whether she disclosed that the firm handling AseraCare’s defense, Bradley Arant, had just hired her son as a summer associate.

The defense team had petitioned Bowdre to separate the proceedings into two parts: the first phase limited to evidence about the “falsity” of the hundred and twenty-three claims in question, and the second part examining, among other things, the company’s “knowledge of falsity.” The Justice Department objected to this “arbitrary hurdle,” arguing that the purpose of the False Claims Act was to combat intentional fraud, not accidental mistakes. “The fact that AseraCare knowingly carried out a scheme to submit false claims is highly relevant evidence that the claims were, in fact, false,” the government wrote. Nonetheless, in an unprecedented legal move, Bowdre granted AseraCare’s request.

Wise man on mountain tells man to shut up and pay attention to movie.

Trial lawyers are expected to squabble over the relevance of the opposing party’s evidence—and, in the private sector, they are compensated handsomely for doing so. But the government lawyers seemed genuinely confused about what the judge would and wouldn’t allow into the courtroom during the trial’s “falsity” phase. In long sidebar discussions, during which jurors languished and white noise was piped in through the speakers, Bowdre berated the prosecution for its efforts to “poison the well” with “all this extraneous stuff that the government wants to stir up to play on the emotions of the jury.” Much of her vexation was directed at Jeffrey Wertkin, one of the Justice Department’s top picks for difficult fraud assignments. A prosecutor in his late thirties, he had a harried, caffeinated air about him and had helped bring about settlements in more than a dozen cases. This was only his second trial, however, and Bowdre was reprimanding him like a schoolboy. “It made me sick to watch her treatment of him,” Henry Frohsin, one of Barger’s partners, recalled. “At some point, I couldn’t watch it, so I just got up and left.”

The judge’s prohibition on “knowledge” during the trial’s first phase constrained testimony in sometimes puzzling ways. Richardson, for instance, could talk about admitting patients, but she couldn’t allude to the pressure she was under to do so. The audit by the Corridor Group that corroborated whistle-blower claims was forbidden because it wasn’t directly tied to the specific patients in the government’s sample. Micca, the former medical director from Atlanta, was not allowed to testify, for the same reason. Nonetheless, over several days, the government’s witnesses managed to paint a picture of AseraCare’s cavalier attitude toward patient eligibility. Its medical directors were part time, as is common in the industry, and workers testified that they’d presented these doctors with misleading patient records to secure admissions. One said that a director had pre-signed blank admissions forms. “Ask yourself: How could a doctor be exercising their clinical judgment,” Wertkin told the jury at one point, “if he’s signing a blank form?”

When Farmer took the stand, Wertkin asked if she was nervous. “A lot nervous today,” she replied. She thought the jurors might judge her for trolling for wheelchair ramps or other recruitment tactics. She needn’t have worried. Bowdre’s restrictions prevented Farmer from testifying about much of anything. “I felt like the judge did not want to know the truth,” she said. “The whole time that I was on the stand, I kept thinking, Why would you not listen to the story?”

The bulk of phase one was dominated by doctors: Liao, the government’s expert, read selections from thousands of pages of medical files to explain why he’d concluded that patients were ineligible, and AseraCare’s medical experts took the stand and disagreed with most of his conclusions. However, the crux of AseraCare’s defense was that the entire debate about eligibility was essentially moot because, although death is certain, its timing is not. A medical director who signed a hospice certification form would have had no way of anticipating whether a patient’s illness would deviate from the expected trajectory of decline. Even Medicare, the defense team emphasized, has noted that predicting life expectancy is “not an exact science.”

After nearly two months of testimony, the jurors deliberated for nine days on phase one. On October 15, 2015, they found eighty-six per cent of the patient sample ineligible for some period of hospice care. Elated, Barger rushed out of the courtroom to call Farmer and tell her that the jury had come back overwhelmingly in the government’s favor. The next part of the trial will be icing on the cake, she remembers thinking.

The next part never happened. A few days later, Bowdre made a startling announcement: she had messed up. The instructions that she’d given the jury had been incomplete, she said, and because of this “major reversible error” she was overturning the jury’s findings and granting a request by AseraCare for a new trial. She invited the government to submit evidence other than Liao’s opinion to prove that the claims were false; the government replied that the record presented ample evidence of falsity. Five months later, in March, 2016, Bowdre granted summary judgment to AseraCare.

It’s unusual for a judge to overturn a jury’s findings, order a new trial, and then declare summary judgment on her own accord, Zack Buck, a legal scholar at the University of Tennessee who studies health-care fraud, told me. The case, he said, “just kept getting weirder.” Wertkin, who had expected to return to Washington, D.C., with that rare article—a jury verdict in a False Claims Act case—later said he felt as though the “rug had been ripped out from under me.”

In a widely circulated opinion, Bowdre wrote that clinical disagreement among doctors was not enough on its own to render a claim false. Otherwise, hospice providers would be subject to liability “any time the Government could find a medical expert who disagreed” with their physician, and “the court refuses to go down that road.” The Justice Department appealed Bowdre’s ruling, but many in the hospice industry celebrated the opinion. “There are huge implications,” Buck said. “So much of our system is based on a doctor’s discretion, and if you can’t say the doctor is wrong you’ve really hamstrung the government’s ability to bring these kinds of cases.” In op-eds and on the lecture circuit, defense lawyers for health-care companies hailed the beginning of a post-AseraCare era.

That year, Dr. Scott Nelson, a family practitioner in Cleveland, Mississippi, was wrapping up a lucrative tour of duty in the hospice trade. Since 2005, Nelson had referred approximately seven hundred and sixty-three patients to twenty-five hospices, fourteen of which employed him as the medical director, according to a special agent in the Department of Health and Human Services’ Office of Inspector General. Some of Nelson’s patients, however, didn’t know that they were dying and a decade or more later remained stubbornly alive.

In the course of roughly six years, by the doctor’s own account, he received around four hundred thousand dollars for moonlighting as the medical director at eight of the companies. Meanwhile, those hospice owners, some of whom were related to one another, received a total of more than fifteen million dollars from Medicare for the patients he’d certified. In a scheme that the special agent, Mike Loggins, later testified was spreading across the Mississippi Delta “like cancer,” hospices bused in vans of people to Nelson’s clinic. The owner of Word of Deliverance Hospice—one small-town provider that briefly put Nelson on its payroll—bought a three-hundred-thousand-dollar Rolls-Royce that was later confiscated by the government. Nelson, who was convicted earlier this year of seven counts of health-care fraud, told me that he’d fallen victim to greedy hospice entrepreneurs who had done hundreds of “third-grader-level forgeries” of his signature when racking up illegal enrollments, and that he’d assumed other forms he’d signed were truthful. Nelson awaits sentencing and has filed a motion challenging the verdict.

The Mississippi Delta has an acute shortage of primary-care providers—a problem that contributes to the region’s poor health outcomes. When I visited some of the fraud victims in the case, all of whom were Black, they told me that the experience of being duped had deepened their mistrust of a health-care system that already seemed out of reach. Some of the patients Nelson had approved for hospice were in their forties and fifties. One had cognitive disabilities, and another couldn’t read. Marjorie and Jimmie Brown, former high-school sweethearts in their seventies, found out that they had been enrolled in Lion Hospice only in 2017, when Loggins knocked on the front door of their yellow brick bungalow. A worker for Lion had tricked the Browns into trading away their right to curative care, and Nelson—whom they’d never heard of, let alone seen—was one of two doctors whose names were on the paperwork.

Losing access to care is hardly the only thing that can go wrong for patients inappropriately assigned to hospice. In May, 2016, Lyman Marble found his wife, Patricia, unresponsive and lying face down in their bed. At a hospital near their home in Whitman, Massachusetts, doctors were shocked by the high doses of opiates she’d been prescribed. An addiction specialist later observed that she was ingesting the equivalent of dozens of Percocet pills a day. Only after Lyman told the doctors to “flush her out like Elvis” did her family come to suspect that her health crisis was caused by hospice care itself.

The Marbles, who had been married for more than fifty years, worked together in a variety of jobs, among them operating an outer-space-themed carnival ride. Five years earlier, Patricia had been admitted to a hospice owned by Amedisys, the third-largest provider in the country. The diagnosis was end-stage chronic obstructive pulmonary disease.

She was seventy years old and had health troubles: she used a wheelchair and supplemental oxygen, and had diabetes, hypertension, and a benign tumor that caused her pain. That pain had been treated by a fentanyl patch, but once she was in hospice the medical director, Dr. Peter Roos, prescribed morphine, Vicodin, Ativan, and gabapentin, too. Over the next five years, he kept prescribing narcotics, recertifying her for hospice thirty times. (Roos, who said in a deposition that he prescribed morphine to ease Marble’s respiratory distress, did not respond to requests for comment.) Court documents later revealed that cash bonuses were a reward for good enrollment numbers at that branch of Amedisys, and that nurses had resigned after being pressured to admit and recertify patients who they didn’t think were dying.

Squirrel leaving wife to go climb on power lines.

While under the care of Amedisys, Patricia sometimes couldn’t remember who or where she was. “I felt like I was dead,” she later said. “It just made me feel like ‘That’s right, I’m in the right place because I’m going to die.’ ” But after Lyman learned that he could “fire hospice,” as he put it, and Patricia was slowly weaned from narcotics, her memory began to return and her breathing improved. Lyman, who had thought that he might lose his wife at any moment (at one point, Amedisys had asked if he was making funeral arrangements), was stunned by her transformation. Today, more than a decade after first enrolling in hospice, Patricia remains opioid-free, and has described her lost years as like being on “the moon or someplace.” For that misadventure, the company billed Medicare almost half a million dollars. Last year, Amedisys settled a suit brought by the Marbles, for $7.75 million. The company declined to comment, stating that the settlement was confidential.

Because pinpointing what constitutes a “good death” is nearly as difficult as determining what makes a good life, families may not always realize when hospice is failing them—even when they work in the industry. In November, 2014, Carl Evans, a seventy-seven-year-old former janitor from Orange County, took a fall and, when hospitalized, was tentatively diagnosed as having end-stage thymus cancer. Soon after, he was discharged to a nursing home and enrolled in a hospice run by Vitas, one of the largest providers of end-of-life care in the United States. Andrea Crawford, one of his daughters, was a hospice nurse and had worked for the company early in her career. When she visited her father in his private room, which had a sofa and a flat-screen TV, he told her that he was being treated “like a king.”

Evans had been living independently, with his longtime girlfriend, before his fall. And, unlike many hospice patients, he remained mobile and gregarious, with a big appetite much noted in his charts. Early in the morning of November 22nd, in search of a non-institutional meal, he climbed out a window and got on a bus to his girlfriend’s house. (His preferred ride, a lovingly maintained burgundy Trans Am, was unavailable.) A family friend eventually located him, thirty miles away.

On Evans’s return, Dr. Thomas Bui, a medical director at Vitas, placed an urgent order for him to receive phenobarbital, a barbiturate that is sometimes prescribed for agitation and can cause extreme drowsiness. A few days later, Vitas records show, Bui added Keppra, an anti-seizure medication that also has sedative properties, to the mix. Evans had no known history of seizures, and Crawford later suspected that the two drugs had been prescribed to subdue him for the convenience of the staff. After the addition of Keppra, his chart shows, Evans became wobbly on his feet and then so lethargic that he couldn’t get out of bed—though he remained alert enough to be terrified at his sudden decline. Crawford, concerned, attributed the change to the drugs he was taking, as did a Vitas employee, according to medical records. On December 6th, Evans died.

The official cause of death was cancer (hospice patients are not typically given autopsies), but Evans’s family filed a suit against Vitas and Bui. The lawsuit was settled, and Vitas denies allegations of wrongdoing. Bui, who said in a deposition that he medicated Evans to soothe his agitation, didn’t respond to requests for comment. The California medical board disciplined him for his handling of the case. He was placed on a three-year probation, during which he was prohibited from practicing alone, and was ordered to take a course on safe prescribing.

Malpractice cases against hospices are rare. As Reza Sobati, an elder-abuse lawyer who represented Evans’s family, told me, “The defense we often get in a nursing-home case is that they were going to die anyway from their issues. That’s even harder to overcome with hospice, since a doctor has literally certified it will happen.”

Afterward, as Crawford reviewed medical charts and tried to understand what had happened to her father, she came across some notes that surprised her. When Evans entered hospice, Vitas had certified him for a heightened level of care intended for patients with uncontrolled pain or severe and demanding symptoms, which Evans didn’t have. As a hospice nurse, Crawford knew that such coding allowed Vitas to bill Medicare more—roughly four times more—per day than the rate for a routine patient. (Vitas denies inappropriate billing.)

In 2016, not long after Judge Bowdre dismissed the AseraCare case, someone began to anonymously contact companies that were the subjects of sealed qui-tam complaints. Those sealed complaints named the whistle-blowers and the details of their accusations—information that the accused companies could use to get ahead of government investigators and their subpoenas, or possibly to intimidate informers into silence. When a general counsel at a tech firm returned the mysterious voice mail, the insider, who called himself Dan, offered to share a complaint that named the company in exchange for a “consulting fee” of three hundred thousand dollars, preferably paid in bitcoin.

The lawyer alerted the F.B.I. and began recording his conversations with Dan, including one arranging the handoff of the documents in Silicon Valley. On the morning of January 31, 2017, Dan texted an F.B.I. agent posing as one of the tech company’s employees the address of a hotel in Cupertino and instructed him to sit in the lobby on “a chair with a newspaper on it” just past “the water station.” Moments after the undercover agent sat down, Dan approached him with a copy of the complaint and was arrested. It turned out that Dan, who the F.B.I. said was disguised in a wig, was the former government prosecutor Jeffrey Wertkin.

By then, Wertkin had left the Department of Justice to become a partner at the élite law firm Akin Gump, a job that paid four hundred and fifty thousand dollars a year. His bio on the company’s Web site noted that, after leading more than twenty fraud cases, he had “first-hand knowledge of the legal and practical considerations that shape government investigations.” As part of a plot that his former Justice Department colleagues termed “the most serious and egregious example of public corruption by a DOJ attorney in recent memory,” Wertkin had, on his way out the door, taken at least forty sealed qui-tam complaints belonging to the Civil Fraud Section.

He later ascribed his short-lived criminal spree, which his defense team compared to “a scene out of a B-grade action movie,” to what had occurred in Judge Bowdre’s courtroom. Wertkin’s wife said in a letter to the court that he had returned home from the AseraCare trial a “shell of a man,” who drank heavily and spent several days watching movies on his phone in bed. Wertkin, who pleaded guilty in 2017 and was sentenced to two and a half years in prison, wrote in a statement that the government’s reversal of fortune in the case had led him “to question things I never doubted before. Does the system even work?” At his sentencing hearing, a prosecutor argued that the False Claims Act itself was one of Wertkin’s victims. “The False Claims Act is incapable of deterring fraud if the Department of Justice can’t be trusted by whistle-blowers,” she said. “We have no way of measuring what chilling impact there might be on whistle-blowers based on what the defendant did in compromising their secrecy.”

On September 9, 2019, the False Claims Act took a second hit when the U.S. Court of Appeals for the Eleventh Circuit published a long-anticipated ruling on the AseraCare case. The judges concurred with Bowdre that the government needed more than the testimony of an outside expert to prove a claim was false. However, they vacated Bowdre’s summary judgment, saying that the prosecution should have been able to present all its evidence, including AseraCare’s alleged “knowledge of falsity,” and sent the case back to her courtroom for a retrial. “When the goalpost gets moved in the final seconds of a game,” the judges wrote, “the team with the ball should, at the least, have one more opportunity to punch it into the endzone.”

The government did not appear enthusiastic about trying the AseraCare case for a second time before Bowdre, though. Wertkin had been disbarred and was serving his sentence, and some of his former colleagues had left for the private sector. In February, 2020, eleven years after Farmer and Richardson filed their complaint, the government reached a settlement with AseraCare, for a million dollars. As in most such settlements, AseraCare paid the sum, admitted no wrongdoing, and was allowed to keep billing Medicare. Jack Selden, a partner at Bradley Arant who worked on the defense team, told the trade journal Law360, “When a case settles for $1 million where the claims have been for over $200 million, I think that speaks for itself.”

Game showstyle wheel with arrow and different versions of saying no.

From a certain point of view, Wertkin’s attempts to shake down government contractors made manifest the transactional logic that governs the False Claims Act. Even to some of their biggest beneficiaries, these qui-tam settlements have come to resemble a mutual-protection racket: executives keep their jobs and their companies keep billing Medicare; whistle-blowers and their lawyers get a cut; and Justice Department attorneys can cash in on their tough-on-fraud reputations by heading to white-shoe law firms to defend the companies they once prosecuted.

In 2020, not long after AseraCare settled with the government, the company was bought for two hundred and thirty-five million dollars by Amedisys, which was facing qui-tam troubles of its own. A nurse from an Amedisys office in South Carolina had filed a lawsuit accusing the corporation of admitting ineligible patients, falsifying paperwork, and handing out bonuses to staff to entice new recruits. (Amedisys denies the allegations.) This time, the government has declined to join the nurse’s case.

Earlier this year, when I visited Farmer at her home in Alabama, boxes were piled in the living room. She was preparing for an upcoming move to Missouri, where her husband had taken a job with a nonprofit hospice-and-home-health company. Farmer had remained close with Richardson, who told me, “I have a whole different view of justice in America now. It’s definitely powered by the dollar bill.” But the women no longer talked about the trial. “Nobody really cared,” Farmer said. “The government didn’t care, the judge didn’t care, and all of these people’s money was wasted.” Sitting in a plush reclining chair, Farmer let out a short, sharp cough as she spoke. In December, she had been diagnosed as having an aggressive form of breast cancer, and the chemotherapy had left her vulnerable to lingering infections.

The hospice benefit imposes a dichotomy between caring for the living and caring for the dying, when, in truth, the categories are often indistinguishable. Most older people will face a chronic disability or a disease in the last years of their life, and will need extra care to remain safely at home. That help is rarely available, and Americans often end up in a social-welfare purgatory, forced to spend down their savings to become eligible for a government-funded aide or a nursing-home bed. “We all think it’s not going to affect us, but if you have a stroke and go bankrupt you’re not just going to go out and shoot yourself in the desert,” Dr. Joanne Lynn, an elder-care advocate and a former medical officer at the Centers for Medicare and Medicaid Services, told me. Once you cross over into the kingdom of the sick, she said, it’s easier to see that some problems classified as hospice fraud are really problems of the inadequate long-term-care system in this country.

In the nineteen-seventies, Lynn worked at one of the first hospices in the United States. At the time, most of the patients had cancer and died within weeks; the six-month guidance was originally designed around their needs. Today, the majority of hospice patients have chronic illnesses, including heart disease and dementia. And some of them—regardless of whether they have six months or six years to live—depend on hospice for in-home support and holistic services that would otherwise be unavailable. Yet under the current system, as the number of patients with ambiguous prognoses rises, providers (including ethical ones) are under financial pressure to abandon those who don’t die quickly enough. It’s a typically American failure of imagination that people with dire but unpredictable declines are all but left for dead.

Elisabeth Kübler-Ross thought she understood why societies isolate the old and the dying: they remind the rest of us of our own mortality. This aversion might partly explain why decades of warnings about hospice care—including a full quarter century of pointed alerts from the inspector general’s office at the Department of Health and Human Services—have gone largely unheeded. Recently, though, some of the reports were so disturbing (maggots circling feeding tubes, crater-like bedsores) that members of Congress have called for reforms, and the Centers for Medicare and Medicaid Services is enacting a few. The agency has just begun making available to the public a greater range of data on hospice providers, including the average number of visits that nurses and social workers make in the last days of a person’s life. More significantly, the agency now has the power to impose fines on problem providers, should it choose to use it. (Previously, the agency’s only consequential penalty for bad hospices was to boot them from the Medicare program, an option it seldom exercised.)

Some state lawmakers, too, are asking deeper questions about end-of-life care. This year, in the wake of a Los Angeles Times investigation, California placed a moratorium on new hospices, and state auditors raised alarms about a raft of tiny new hospices, some with fictional patients and medical staff, that were engaged in “a large-scale, targeted effort to defraud Medicare.” In Los Angeles County alone, there are more than a thousand hospices, ninety-nine per cent of them for-profit. By comparison, Florida, which, unlike California, requires new providers to prove a need for their services, has fifty-one hospices.

But when regulators close a door they sometimes open a window. Licensing data I’ve reviewed suggests that, as scrutiny of end-of-life-care providers intensified in California, the hospice boom travelled eastward. In Clark County, which contains Las Vegas, the number of new hospices has more than doubled in the past two years, and in Harris County, which encompasses Houston, the number has grown almost as quickly. Sheila Clark, the president of the California Hospice and Palliative Care Association, attributed some of the surge in new licenses to a scheme called “churn and burn.”

“Providers open up a hospice and bill, bill, bill,” she said. Once that hospice is audited or reaches the Medicare-reimbursement limit, it shuts down, keeps the money, buys a pristine license that comes with a new Medicare billing number, transfers its patients over, and rakes in the dollars again. The directors of two nonprofit hospices in the Southwest told me that they had been accepting patients who were fleeing such new providers. Some patients switched because while they were with the startup hospices they hadn’t seen a nurse in two weeks, and no one was answering the phone.

On a rainy morning in November, I found myself in a vast, sand-colored commercial plaza on the outskirts of Phoenix. The complex was designed in the style of a Spanish hacienda, with a central courtyard, a stone fountain, and a stately bell tower. Maricopa County was another place where the number of hospices had doubled in two years; thirty-three new ones, licensing data indicated, had appeared at this single address. There was no building directory, but eventually I realized that most of the hospices were clustered together on the basement level. All the hospices listed the same phone number for inspectors to call, and some had taped the same apology to their door: “Sorry we missed you! We’ll be back in 45 mins, if you need immediate assistance pls call us.” Each time I called the listed number, I got an answering machine whose mailbox was full.

When I buzzed the Ring video doorbell of B-116, which housed at least nine hospices, I was told by the man who answered that the manager was currently on the other side of the building. When I walked to the other side and rang B-117, the same man picked up. Sensing my confusion, he said, “I’m just the voice at the door.” His name was Ted Garcia, and he had been hired to monitor the hospices from his laptop at home. I told him that I was searching for a registered nurse named Svetik Harutyunyan, who was listed as the C.E.O. of multiple hospices in the neighborhood, among them Ruby, Sapphire, and Garnet, which were within the complex, as well as Platinum, Bright Star, and First Light, down the road. I told Garcia that I particularly wanted to ask Harutyunyan about Ruby Hospice, which I’d seen listed for sale in an online ad for a quarter of a million dollars.

The day before, I’d searched for her at a squat building in Los Angeles that had drawn auditors’ attention. That address holds, according to state records, a hundred and twenty-nine hospices—a tenth of the city’s supply. When I knocked on the door of a hospice that the licensing data had linked to Harutyunyan, a worker told me that no one by that name was involved. Later, when Harutyunyan and I spoke by phone, she acknowledged owning hospices in California and Arizona and said that the arrangement was legal. She had wanted every member of her family to have one, she said.

Garcia told me through the doorbell that, as far as he understood, the hospices he monitored weren’t seeing actual patients; instead, the offices were a kind of “holding pen” to keep the licenses viable with requisite physical addresses until demand could be drummed up. The remote work was dull, he allowed. Apart from inspectors occasionally stopping by and transient people defecating outside the doors at night, my visit was the most action he’d seen in months. As the rain let up and I sat in the deserted courtyard trying to decide which of Harutyunyan’s holdings to visit next, it occurred to me that this world of paper hospices—empty of patients, valued at six figures, watched over by virtual guards—might be the clearest expression of the industry’s untamed frontier that I was going to encounter.

Later that afternoon, Garcia told me that he’d begun to research whether he could open a hospice himself. The market was bigger and more lucrative than he’d realized. People in Montana and Texas and Tennessee, he said, were posting ads online for “turnkey-ready hospices” for as much as half a million dollars. He called an ex-cop he knew to see if he wanted in. “We can turn a profit and split it,” he said. ♦

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Hospice Business Model [How Hospice Works and Make Money]

By: Author Tony Martins Ajaero

Home » Business ideas » Healthcare and Medical » Hospice Agency

A hospice which is also known as palliative care is a business that offers clients a safe and caring environment as they prepare to pass on. Here, terminally ill patients are kept comfortable while receiving round-the-clock medical attention. Family members are offered support and education as they prepare for the passing of their loved ones.

How Does the Hospice Business Work?

Hospice Care Company offers a variety of services. Some may differ from others, so it is recommended that you choose the best service that suits your needs. The list below contains the most common services that hospice companies provide.

24/7 Round-The-Clock Care

Hospice care is said to be comparable to having a doctor’s office in wheels because service is available 24/7, patients can call the service if they need assistance with anything. Often it is used for activities that require physical labor such as going up and down the stairs, taking a bath, cooking for meals, etc.

Hospice care companies can offer a “comfort kit” that contains medicines to treat symptoms that come with end-of-life care. Fever, breathing problems, dizziness, and pain are some of the symptoms the kit can alleviate.

Access To Healthcare Experts

To ensure that patients receive the best care, hospice services hire medical experts . They are tasked with keeping the patients comfortable with the right kind of medication to alleviate the pain.

Accomplishing Bucket Lists

Everyone has a list of things they wish to do before they die. When patients are in a hospice facility, the glaring truth of what they are facing can lead to depression. Hospice services aim to combat that by providing unique programs to help patients forget the reality they face and just have fun.

Spiritual Support

Most people at end-life care start to question the way they have lived their lives. This is when existential questions can come churning out. Leaving them unanswered could affect the patients’ health negatively. That is where spiritual counselors come in. Most services offer a spiritual counselor (or an appropriate alternative for religious patients).

Spiritual support tends to ease the patient’s spiritual burden. It fills an emotional hole most patients don’t realize they had and allows them to embrace the afterlife without regrets. It also relieves stress that comes from major life changes associated with hospice care.

Medical Equipment

Dealing with terminal illness could mean the need for equipment that assists with a patient’s quality of life. This may include a hospital bed, oxygen equipment, blood pressure monitors, and lifts.

Physical Therapy

To avoid developing harmful health conditions that could affect the quality of life, physical therapy is often recommended for most patients. It keeps them as healthy as they can be despite their conditions.

Volunteers For Company

Being at the end stage of life comes with limitations such as lesser time outdoors or even having fewer people over to visit. Hospice services can include sending in volunteers to entertain the patient within the comfort of their home. Humans are social creatures and studies show that patients do better emotionally if they have someone to talk to.

Respite Care

It is understandable that a family caregiver would want to take a break from taking care of a terminally ill loved one. Hospice companies can take over for a few days to give them time to rest. This benefits both the caregiver and the patient because the caregiver comes back fresh and well-rested. It eases the physical and emotional burden significantly and puts everyone at ease.

  How Does Hospice Businesses Make Money?

Hospices spend more money at the beginning and the end of a patient’s care. They profit most in the days when a care routine has been established. This has led to some hospices enrolling patients who are healthier and therefore give the hospice fewer expenses to deal with while still receiving the $160 per day of the patient’s stay. Hospice make money from the following sources;

Charitable donations and grants make up a great portion of their revenue. Most of them are supported by third-party donors and grantmakers.

The funding necessary to cover essential hospice care services usually exceeds the financial means of many developing companies in the industry. Healthcare services may have to be complemented by non-governmental organization grants.

Medicare Hospice Reimbursements

Medicare reimbursement pays for 84 percent of patients in hospice care. Medicare reimburses hospice agencies for hospice care at a Par Diem rate, meaning every patient receives the same amount of reimbursement per day despite their diagnosis or individual care needs.

The reimbursement system may be creating incentives for hospice agencies to select patients with fewer care needs and longer hospice stays. By doing so, for-profit agencies may be conserving money by providing less intensive care.

In the United States, children with disabilities or adults who meet Medicaid’s financial eligibility criteria are fully catered for in terms of hospice care.

Medicare beneficiaries who are dual-eligible for both programs (approximately 20 percent of all Medicare beneficiaries) can have Medicaid cover costs that Medicare doesn’t cover such as outpatient prescription drugs and long-term care.

Have it in mind that Medicaid and Medicare’s hospice eligibility requirements are almost identical, a patient must be certified to have six months or less to live and must receive services from a Medicare-certified hospice facility or agency.

Coupled with covering hospice services, Medicaid also pays at least 95 percent of room and board costs for hospice patients in a nursing home. Funds are allocated to the hospice agency which then pays the nursing facility.

Private Insurance

It is important to note that private insurance plans vary widely in terms of coverage, but it usually includes hospice care since it is much less expensive than hospital treatment. Some policies that cover hospice care may have limits on hospice expenses.

Individuals Payment from Their Pockets

Have it in mind that individuals without private health insurance who are not covered by a government policy are expected to pay for hospice care themselves. Some hospice care can be paid on a sliding scale or through charitable or other donations.

Tricare is a healthcare program sponsored by the U.S. Department of Defense that provides health benefits for active military personnel and retirees and their dependents. Hospice care is covered through this program.

CHAMPVA (civilian health and medical program of the department of veteran affairs) is a healthcare program sponsored by the veteran administration that insures eligible beneficiaries. This program covers most medically necessary care including hospice

How to Start a Hospice Business

To start a hospice business there are detailed steps to consider.

Business Plan

A clear plan is essential for success as an entrepreneur. It will help you map out the specifics of your business and discover some unknowns. A few important things to consider are:

  • What are the startup and ongoing costs ?
  • Who is your target market?
  • How much can you charge customers?
  • What will you name your business?

Cost Involved in Opening a Hospice Business

Startup cost varies depending on the type of Hospice care you wish to provide and which country and state your business is located in.

If your business plan includes opening a licensed home health non-Medicare facility, start-up costs are estimated within the range of $60,000 to $100,000 while Medicare-centered hospice agencies should budget for $150,000 to $350,000.

Investment includes:

  • Licensing for faculty and staff
  • Computer hardware and software
  • Commercial space for office and/or medical facility
  • Accreditation
  • Website, logo, business cards, and other printable material
  • Marketing strategy and materials

Due to strict regulations many looking to enter the hospice industry choose to invest in consulting services or a franchise. While this requires additional start-up capital, entrepreneurs receive guidance throughout the process. Profits are maximized as time and resources are properly allocated from the moment the facility’s doors open.

Ongoing Expenses for a Hospice Business

In addition to the standard operational expenses, you will face several ongoing costs ranging from $375,000 to $425,000 (and higher).

Exact numbers vary depending upon the size of your facility and the services you offer. Payroll will consume the greatest portion of your budget with fees and licenses coming in second. Business owners should also budget for travel and continuing education for employees which will ensure the highest level of care for each patient.

The Target Market for a Hospice Business

Hospice care is reserved for terminally ill patients with a life expectancy of 6 months or less. If an individual lives beyond that time frame, the medical director or physician must re-certify that they are terminally ill.

Companies Operating Hospice Business

  • Hospice of the Valley

Related Posts:

  • 7 Unique Characteristics of a Great Hospice Business
  • Hospice Agency Vs Hospice Care Center: What is the Difference?
  • How Much is Florida License for Hospice Care Per Patient?
  • 20 Best Fun ideas for Hospice Patients
  • 20 Best Hospice Marketing ideas and Strategies
  • 15 Best Stethoscope for Hospice Nurses
  • Best Vision and Mission Statements for Hospice

What is The Model - Multi-Pedia

What is the model.

The Model™... is a management approach for the modern Hospice organization. The Model™ helps create a high-quality, predictable Hospice experience that is financially balanced and is thus sustainable. The Model™ begins with the front-lines of care and works backwards to areas and functions that support the patient/family experience .

In other words,

The Model is the intentional design of a Hospice culture that simultaneously balances purpose and financial realities to create a sustainable World Class experience.

The Four Areas of Design Work

At the heart of the Model are four areas of design work that are essential to truly successful Model implementation. They are:

  • Team Design
  • Visit Design
  • Product Design
  • Supporting Services Design

The first three of these areas (Team, Visit and Product Design) focus on patients and families since this is the heart of what we do. The design of Supporting Services is important as these functional areas are necessary to serve the people on the front-lines of care, providing help and assistance to make the provision of care possible. When a Model is properly implemented, it results in superior Hospice care that is balanced. As we dream about "what" and "how" Hospice care can be provided, the Model tools give us a great indication of the financial implications of our design choices.

If you would like more information or have questions about The Model Hospice management approach or its implementation, click here to go to the MVI website for contact information.

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