Protecting and strengthening the integrity of hospice care is essential to ensuring that terminally ill New Yorkers receive compassionate, appropriate, and high-quality end-of-life care. For that reason, I strongly urge Governor Hochul to sign S3437/A565 to prevent further expansion of for-profit hospice programs in New York State.
New York has long recognized that certain healthcare sectors serve a public good and must remain insulated from profit-driven motives. This is why New York’s general hospitals are required to operate as nonprofit entities. Hospice care, like hospital care, should be held to nonprofit-only status in New York.
Around 70% of hospice centers across the country are now for profit, even though studies from other states have consistently shown that for profit hospices engage in profit driven practices that reduce the quality of care they offer including cherry-picking patients, reducing staff, offering less services, and aggressively marketing to those who may not need hospice.
Opponents of this bill claim that New York’s comparatively low hospice utilization rate is evidence that more providers, including for-profit entities are needed. This is simply not true. Hospice utilization in New York is low, not because of our number of providers, but because we suffer from a lack of public and professional education about the Medicare hospice benefit, persistent misconceptions about what hospice means for a patient’s future, and an over divergence of patients to skilled nursing facilities, which effectively blocks hospice enrollment due to the fact that hospice cannot be elected concurrently with skilled rehabilitation. Allowing for-profit hospices to proliferate will not solve these underlying problems.
Opponents also point to New York’s Certificate of Need (CON) process administered by the New York State Department of Health, which they argue can root out any bad actors before they receive a license to practice. While the CON is an important regulatory tool, it is not an adequate safeguard to prevent the entry of for-profit hospice entities into New York. The CON process is designed to evaluate operational feasibility—not mission integrity – meaning that the review focuses primarily on whether an applicant is financially viable, whether there is a defined “public need,” and whether the proposed program meets baseline regulatory requirements. It is not designed to assess the ethical commitment, mission-driven values, or long-term quality practices that are essential in hospice care, where vulnerable patients and families rely on trust, continuity, and compassion.
In fact, because the CON process relies so heavily on evaluating financial capacity, large for-profit chains often appear particularly strong in the review process, even if they are falling short when it comes to their actual care. Furthermore, quality commitments are not written into CON applications and enforcement is limited to periodic surveys. These reviews cannot detect or prevent problematic patterns associated with for-profit hospice expansion, including selectively admitting patients with high reimbursement and low care needs, minimizing RN and social work visits to reduce costs, or using aggressive marketing to enroll patients who are not hospice appropriate Once a provider is approved, the state has limited mechanisms to intervene until harm has already occurred.
Recent polling conducted by Siena demonstrated that New Yorkers understand the importance of protecting the integrity of hospice and strongly support a prohibition on for-profit hospices. The poll also showed that a significant majority of New York voters want the state to strengthen protections, especially for seniors, against the kind of waste, fraud, and abuse that takes place at for-profit hospices.
In addition to being popular, this legislation would directly support the intent and promises set forth in New York’s Master Plan for Aging, a plan built on the core principles of ensuring that older New Yorkers are treated with dignity, respect, protection, and compassionate care as they age. However, allowing the expansion of for-profit hospice entities, despite overwhelming evidence of quality concerns in other states, would expose older adults to unnecessary risks, undermine continuity of care, and weaken the very protections New York’s Master Plan promises.
S3437/A565 has already passed both legislative houses with bipartisan support and is on the Governor’s desk. All she needs now is to sign it into law.
Cara Pace is president and CEO of United Hospice.
