Private Equity Ownership in Hospice Care: A Systematic Review (2012-2026).
Denise D Quigley, Shannon Walsh, Cordt T Kassner and 2 others
PMID 42522110WHAT IT FOUND
Hospice care experiences were worse in private equity-owned agencies than in nonprofit and other for-profit hospices, especially communication with families and timely care.
Emotional and religious support did not differ. Evidence is limited to six studies.
Key findings
01Bereaved caregiver reports were worse in private equity-owned hospices than in nonprofit and other for-profit hospices for overall rating, willingness to recommend, and most care experience domains, except emotional and religious support.
02The largest reported differences were in communication with family and getting timely care, where hospices not owned by private equity had better care experiences.
03One study found private equity-owned hospices had the highest profit margins and lowest spending on direct patient care and non-salary administrative services, with per-patient-day nursing salary expenditures of $43 in nonprofits and $34 in private equity-owned hospices.
STILL TO COME
How it was doneWhat they foundWhat it means for RNs
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What it does not show
Only 6 studies met criteria, and most were descriptive, so the review cannot establish that private equity ownership caused worse care. No included study examined vulnerable populations such as nursing home residents, people with dementia, or rural patients. Studies used different methods to identify private equity ownership and disagreed about prior ownership status. Two reviewers screened and appraised study quality, but the small number of studies and heterogeneity in designs, populations, and outcomes limit comparison. Care experience findings came from 2 studies using bereaved caregiver surveys, not direct measures of care processes. Financial findings came from 1 study. Four studies met at least 80% of quality criteria and two met 75%. The most common reason for lower scores was limited strategies to identify and adjust for potential confounding factors.
Declared interests
The authors declared no potential conflicts of interest.
The easy way to misread this
Do not conclude that private equity ownership causes worse hospice care or that every private equity-owned hospice delivers poor care. The review reports associations from six mostly descriptive studies, with inconsistent ownership classification and no evidence about vulnerable populations.