Hospice Care Is Going Corporate, With Help From Roto-Rooter

Hospice care is a booming $14 billion industry. Each year, 1.5 million Americans die while in hospice. That’s 44 percent of the total, and the figures are growing, according to Changing the Way We Die, by health writers Fran Smith and Sheila Himmel.

I picked up this revealing new book because of a slightly morbid interest in the funeral home and cemetery businesses. Not long ago, I took a look at how consumers have sometimes suffered as the “death care” industry has consolidated into increasingly gigantic publicly traded corporations such as Service Corporation International. Similar issues are arising in the traditionally fragmented hospice sector, Smith and Himmel write.

Hospice suffers from lingering misperceptions. It’s not necessarily a woo-woo institution meant to mystify terminal illness to the tuneless chant of a Tibetan monk choir. It’s also not necessarily a physical place; one can receive hospice care at home. Instead, it’s a collection of practices bound by a philosophy that the seriously and terminally ill should receive palliative care addressing pain and other symptoms, as opposed to a relentless barrage of treatments aimed at keeping the machinery going regardless of the quality of life or the patient’s subjective wishes. Hospice providers focus on their patients’ emotional, as well as physical, needs.

Disclaimer: If you can’t tell from how I’m describing it, hospice strikes me as a sensible approach for many situations and individuals.

Smith and Himmel report that “for-profit hospices account for all the growth in the field over the past decade”—a shift away from the nonprofit model that the authors find troubling. They tell some interesting tales about the for-profit hospice tycoon Reverend Hugh Westbrook of Dallas and his Vitas Innovative Hospice Care chain. It was acquired in 2004 by Roto-Rooter, which kept the Vitas name but eventually rebranded the corporate parent Chemed. Private equity and venture capital firms are getting into the hospice game, the authors explain, as is the Washington Post Co. (now called Graham Holdings), which sold its newspaper in 2013 but kept its hospice holdings.

Even if you’re not intrigued, as I am, by the corporate machinations, Changing the Way We Die offers a bracing introduction to hospice at a time when an aging nation needs to consider alternatives to expensive and often inhumane traditional medical practices.

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