The Spark

the Voice of
The Communist League of Revolutionary Workers–Internationalist

“The emancipation of the working class will only be achieved by the working class itself.”
— Karl Marx

Hospice Care:
Stealing from the Dying

Jan 9, 2023

Hospice allows people to die at home instead of spending their last days in the hospital. Terminally ill patients are supposed to receive care to treat pain and help with tasks like bathing, medications, and housekeeping, while giving up treatments aimed at curing them.

When it was introduced in the 1960s, and expanded in the 1970s and 1980s, it was presented as a benefit for patients, who could die with more dignity surrounded by loved ones, and as a cost saving plan for Medicare, because sending nurses and other workers to patients’ homes is still much less expensive than hospitalization. And for decades, hospice seemed to be accomplishing these goals.

At first, charities and non-profit organizations provided all hospice care. But over the last decades, every pot of public money to pay for something the population needs has been raided by profit-making bandits, and hospice is no exception. Hospice is now a 22-billion-dollar-a-year industry, still almost entirely funded by taxpayers, but for-profit hospice companies make up more than 70% of providers.

Companies make a profit off hospice in one simple way: they charge Medicare more than they pay for the services they provide. Medicare margins, or the difference between money these hospice companies collect from Medicare and the money they pay for services, are three times higher at for-profit hospice companies than their nonprofit counterparts. In other words, these companies profit by enrolling as many hospice patients as possible while providing as little care as they can get away with.

Like every other company, hospice providers hire as few people as they can get away with, so there are not nearly enough nurses, aides, or social workers. A 2016 study found that more than 12% of hospice patients got no visits from hospice workers in their last two days of life, meaning many died in filth and pain.

Even when hospice workers do visit, they are increasingly exhausted and given little time to provide care, run ragged by driving across whole regions or even whole states. A government review of hospice inspection reports from 2012 to 2016 found the majority of all hospices had “serious deficiencies,” including failures to manage pain and treat bedsores—yet the government did nothing to address these “deficiencies.”

Hospice companies also have an incentive to enroll as many patients as possible. The New Yorker magazine reported that some hospice companies have given their workers steep quotas for the number of patients they must enroll, regardless of how many people are terminally ill in the area. Patients have been enrolled in hospice without even knowing about it.

But while companies profit by keeping as many hospice patients as possible, the federal government demands repayment from a company if the average patient is on hospice more than six months—so when they have too many patients living too long, these companies “graduate” patients from hospice, which means they lose diapers, pain meds, wheelchairs, nursing care—even their hospital bed!

If we don’t want to accept seeing our loved ones—and ourselves—die in pain and filth, we will have to organize to take the wealth back from these thieves and use it to meet the population’s needs.