Sale of Hospice Northwest To For-Profit Corporation

Hospice of the Northwest has been a vital anchor for Skagit County and 3 other counties we serve—Snohomish, Island, and San Juan—for decades. People with life-limiting illnesses, their families and circles of support have been receiving exceptional care by dedicated interdisciplinary staff and volunteers who commit their lives and hearts to making sure all experience our mission: Compassion and Dignity for Every Moment of Life . Hospice of the Northwest was even voted “Best Place to Work in 2018” in the country by the national organization Modern Health Care. In our most recent accrediting survey by CHAP, Hospice of the Northwest was told that we are a model by which all other agencies should be measured.

All the way around Hospice of the Northwest is a valuable organization that is unmatched in the county, state or nation.

That is why it is so disturbing to learn that the two Skagit public healthcare districts who own Hospice of the Northwest (Skagit Regional Health Care District 1 and United General District 304) are in discussions to sell Hospice of the Northwest to the for-profit, private equity-owned organization Bristol Hospice.

So many things are alarming about this potential sale.

Firstly, the company that owns Bristol is Webster Equity Partners which has been buying up multiple hospices and who has already purchased 3 hospice organizations this year. According to Webster’s own website no one – NO ONE – on their team has any healthcare experience. They have experience buying healthcare organizations, but no experience working within them or understanding what it takes to provide quality care to people; especially those at the most critical and difficult times in their lives.

This is an increasing trend across the country with many for-profit, venture- and equity- based firms buying hospices because they can be made profitable by cutting staff and services, admitting the least expensive patients, and taking in more and more Medicare money. This is wrong on so many levels.*
Secondly, an informal survey of present and former employees of Bristol and the hospices they have purchased across several states has revealed this purchase would likely result in a significant reduction of quality of care by:

  • Reducing the number of staff across all disciplines, which includes reducing MDs
  • Increasing caseloads across all disciplines
  • Limiting home health aide care
  • Terminating research
  • Ending community education and support
  • Elimination of services to certain areas, like San Juan, Whidbey and Camano Islands because of higher costs

Some of the critical services Hospice of the Northwest currently provides, which are often not provided by other hospices would likely be eliminated. This includes: volunteers and complementary therapies such as massage and music. We are able to provide the community with these services, as well as extra services like special equipment and others considered “out of the ordinary” for hospice because these are funded by Hospice of the Northwest Foundation. The Foundation is strongly supported by the community, and our relationship would be severed if Hospice of the Northwest is purchased by a for-profit corporation.

Also, community bereavement would be discontinued. This support is widely available and used by many community members, not just those whose loved ones were on Hospice of the Northwest services. This will be a huge loss to people struggling with grief. We get referrals from physicians, therapists, and word of mouth. Where will these people go?

As reported by an employee of Bristol, from an office in Colorado that was purchased this year:

“ They cannot seem to retain staff, and it feels like everyone is jumping ship the more Bristol policies are enacted.  They are cutting positions and placing more responsibilities on middle management that are not realistic, which consequently adds significant stress to those delivering direct care, and our patients feel it.  We lost so many solid nurses that had decades of experience and people now bet on who is going to leave next.  What was a thriving, successful hospice that valued patient-centered care and the employees who delivered it has evolved into a corporate-centered, dysfunctional business.  Bristol is owned by Webster Capital, a private equity firm based in the northeast. It appears they are buying up everything they can. It’s not surprising that cost cutting and increased profitability have taken center stage while patient care is left somewhere on the backburner.  Meanwhile, we failed two rounds of Medicare review and are currently going through our third round.”

Time and time again, results from corporate buyouts of hospices like Hospice of the Northwest have proven that quality of care declines significantly. Our community has strongly supported Hospice of the Northwest over the years because of the quality and compassionate care they receive. A company with a primary goal of sustained and increased profitability is not going to care for our community the way we do.

As employees of Hospice of the Northwest we are proud of our work, and have been faithful to its mission, supporting our patients and families by making sure our care is the very best! Especially in recent times when so much has been asked of healthcare workers, we have gone even further to advocate for our families and patients to receive the best care from every member of our team regardless of their living situation or COVID status.
If the community would like to see Hospice of the Northwest remain the best in the country and continue to provide the high quality of care it does, they can make their voices heard by contacting:

Commissioners for Skagit Regional Health District 1:
Julie Blazek -
Peter Browning -
Frei Burton -
Bruce Lisser -
Jeffrey Miller -
Dale Ragan -
Gary Shand -
Brian Ivie -

Commissioners for United General Health District 304: 
Andy Hunter -
Jeri Kaufman -
Chuck Ruhl -
Bob Stanley -
Tina Tate -
Ted Brockmann -

Email all Commissioners

If the healthcare districts are truly committed to quality hospice care for the community, they will reject the sale of Hospice of the Northwest .


Dedicated Interdisciplinary Employees of Hospice of the Northwest

*The American Medical Association researched the levels of service of for-profit and not-for-profit hospice services and concluded:

Journal of the American Medical Association:
Study Finds Differences in Benefits, Service at Hospices Based on Tax Status

Results: The authors found that compared to nonprofit hospices, for-profit hospices:

  • Were less likely to provide community benefits, including serving as training sites (55 percent vs. 82 percent), conducting research (18 percent vs. 23 percent) and providing charity care (80 percent vs. 82 percent)
  • Cared for a larger proportion of patients with longer expected hospice stays, including those in nursing homes (30 percent vs. 25 percent)
  • Had higher patient disenrollment rates (10 percent vs. 6 percent, patients who don’t remain in hospice until their death)
  • Were more likely to exceed Medicare’s aggregate annual cap, which is a regulatory measure to control hospice length of stay and constrain Medicare hospice expenditures, (22 percent vs. 4 percent)
  • Were more likely to do outreach to low-income communities (61 percent vs. 46 percent) and minority communities (59 percent to 48 percent), suggesting that the growth of the for-profit sector may increase the use of hospice by these groups and address disparities in hospice use.
  • Were less likely to partner with oncology centers (25 percent vs. 33 percent)

 Conclusion: “Ownership-related differences are apparent among hospices in community benefits, population served and community outreach. Although Medicare’s aggregate annual cap may curb the incentive to focus on long-stay hospice patients, additional regulatory measures such as public reporting of hospice disenrollment rates should be considered as the share of for-profit hospices in the United States continues to increase.”

Skagit Valley Herald: Hospitals considering sale of hospice nonprofit

Mezo’s assessment has some strong evidence to back it up. According to a national hospice survey conducted by Yale University and the Icahn School of Medicine at Mount Sinai, nonprofit and for-profit hospices differ in their contributions to the community, and to patients and their families. For-profit hospice centers are less likely to provide community benefits by serving as training sites, conducting research and providing charity care.

Other studies have found that for-profit hospice centers provide a narrower range of services to patients and families, offer less comprehensive bereavement services to families, have less professionalized staff, and have lower staff-to-patient ratios.

To that morbid end, she points me in the direction of several studies which suggest that for-profit hospice companies, like the one that served her mother, provide less home-care hours per patient than non-profit entities. “With Medicare providing a per diem rate for home hospice care, there is no incentive to provide more than essential care if you’re looking to maximize profit,” she says. Specifically, Johnston cites a 2014 study which found that “nonprofit hospices were more likely to serve patients in the home and in inpatient hospice facilities, while for-profit hospices were more likely to serve patients in nursing homes and assisted living facilities.”

How For-Profit Hospices Compare to Nonprofit Hospices
This 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 and increasing profits by selecting patients who will live longer.
 Compared with nonprofit hospices, for-profit hospices had a lower proportion of patients with cancer (48.4 percent vs. 34.1 percent) and higher proportions of patients with dementia (8.4 percent vs. 17.2 percent) and other diagnoses (43.2 percent vs. 48.7 percent). The data also indicated that approximately two-thirds of patients in for-profit hospices had dementia and other non-cancer diagnoses, whereas only about half of patients in nonprofit hospices had these diagnoses.

Sacramento Bee: California hospices face lax oversight and few rules. The sick and dying pay the price
On the receiving end, hospices — particularly ones seeking profit — may be incentivized to admit patients who will stay longer.

In 2014, the daughter of a woman who died in the care of Bristol Hospice in Roseville filed a complaint with the Department of Public Health, claiming that under Bristol’s care, pressure sores in her mother’s right leg were left unattended, and the sores developed into sepsis and gangrene that ultimately caused her to die.

While the department found that the hospice did violate regulations through its investigation, it did not issue any penalties.

Records from the Department of Public Health obtained by The Bee show that Bristol Hospice continued to violate regulations even after the department released results of its investigation to Bristol. Eight subsequent complaints were filed by patients’ family members and hospice staff. The department ruled in five of them that Bristol had failed to properly train its staff as well as update or follow treatment plans for patients — the same deficiencies the department found in the daughter’s complaint.

“Hospices are rarely inspected,” Connors said. “Most hospice inspections are conducted by private agencies that have strong incentives to ignore poor care.”

“Nothing is done when serious violations are detected,” he continued, “and findings of neglect are covered up.”

Ed Dudensing, the daughter’s lawyer, said the daughter did not give up on the lawsuit for five years in part because she “felt that [the department’s] deficiency finding against Bristol would have absolutely no impact on its conduct going forward.”

“Without a penalty system, Bristol had no fear that its egregious failures in care would result in any interruptions of the operations of this facility,” Dudensing said.