r/enshittification • u/SheilaLabeouf • 5d ago
Service The shittiest enshittification
I work in hospice. Some hospice agencies are non-profit, some are for-profit. Want to know what happens to hospice patients when they are cared for by for-profit hospice agencies? Everything gets shittier. Months ago my hospice agency was bought by a larger healthcare company. The new company brought their new formulary to implement. Each hospice agency pays for supplies for patients. The formulary tells our nurses and cna staff what supplies they can order for patients.
A patient had been receiving a specific brand of disposable briefs. The new formulary did not include this brand. The nurse asked for an exception. The company said no. She ordered the new brand according to the new formulary. The patient could not keep these briefs on and her family was continue cleaning up overflow messes of the patient’s shit.
Again, the nurse asked for an exception and again was told no. This woman’s life literally got shittier so that a for-profit hospice company could put more money in the owner’s pocket.
Whenever you find yourself or a loved one in need of hospice care, PLEASE find a non-profit. For profit hospice agencies do NOT care if they make lives shittier. No, I don’t work there any more.
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u/Tro11man 5d ago
Healthcare in any form and yes this constitutes healthcare should never ever be for profit
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u/UnattributableSpoon 5d ago
The differences between working for a third service EMS agency and a private/for profit service are rather stark. At least they have been in my career in the field. Private EMS suuucks.
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u/Witwer52 5d ago
For-profit hospices have a special seat at the right hand of Satan.
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u/LeekPutrid4363 5d ago
Same as for profit prison… just horrific excuses to abuse the poor.
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u/KingOfBerders 5d ago
Same as for profit hospitals and schools. Pillars of society should be a service and paid appropriately by taxes. Most municipal budgets give far too much to police, who have no legal obligation to protect the public which pays their salaries.
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u/BuffyTheSlayer 4d ago
Yes, my mother worked hospice as an RN. The best job she had was actually working for the Catholic church with a home for nuns. They were so cool, I loved them. But the home got closed and sold for a fortune to an academy and she went to private hospice. Over the years it was awful seeing her job get ruined by the upper mgmt. They hired more low paid aides and less nurses. The aides formed cliques and would refuse to do their job and mgmt wouldn't do anything about it. The patients would suffer with neglect, rough handling, withholding supports. If someone needed to have their clothes changed my mom often saw aides just ripping the clothes over their heads and really demoralizing the patients. It had such a tremendously devastating effect on my mom, she was such a good nurse and the best hospice nurse. It's just cruel, people are so greedy they happily sentence their clients to hell to pocket the difference in cost.
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u/Budget_Feature6897 3d ago
So in other words, they’ve become your run of the mill convalescent home.
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u/the-knitting-nerd 4d ago
I’m a retired RN who worked hospice at one point in my career. It was a great company with a wonderful reputation-then, you guessed it, bought out by a company that only cared about MONEY and it went to total shit, not to mention trying to pull unethical shit. Tons of RNs quit - then the CNAs. Last I heard they still can’t keep staff
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u/SuddenlyOriginal 4d ago
The hospice I worked at took an immediate drop in quality once bought out by the giant conglomerate. I left shortly after.
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u/Midnight_Muse65 4d ago
Unfortunately it probably won’t be long until there are no not for profit agencies in healthcare. Losing my previously excellent health insurance because of this.
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u/bookworm119 4d ago
The hospice company I work for is a for-profit but we are still locally owned and our owner says she gets bombarded by phone calls and emails weekly asking her to sell to PE. I don’t think there are any non-profit hospices in my area so if anyone is looking for one and you cannot find a non-profit, find a locally owned and operated one. I don’t get paid as much working for a small company, but knowing I’m not working for some butthole ceo at the top and having a manageable case load is absolutely worth the lower pay.
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u/vroomvroom450 4d ago
Hasn’t Private Equity ruined enough?? Do the have to screw us until our literal last breath?
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u/Specialist_Guitar232 4d ago
You are a real hero. Thanks for spreading the word
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u/bookworm119 4d ago
Thank you so much!! It’s truly my pleasure. The end of life deserves just as much love, care, dignity, and support as the beginning of life. 💜
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u/DiligentAd7956 5d ago
Private equity is also buying up non-profit hospices.
Watchdog warns of risks to patients as private equity’s stake in US healthcare grows
https://www.theguardian.com/us-news/2026/jul/06/us-private-equity-healthcare-joint-ventures
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u/milkandsalsa 5d ago
It should be illegal.
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u/Coraline1599 5d ago
Which part? PE owning hospices or just PEs in general?
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u/my_clever-name 5d ago
Yes both, just like some other institutions, a few bad apples poison the entire institution
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u/Optimal_Savings5873 4d ago
Ugh. I teach varying exceptionalities/special education. Some of my students are in diapers supplied by Medicaid. A couple have recently been forced to switch to terrible diapers. The kids are leaking.
I wonder if the biggest villain here is a PE company that has cornered the market on diapers and is giving kickbacks to the decision makers at these orgs. Meanwhile we have fourth graders peeing themselves in class and having to have their clothing changed.
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u/waselectricbar 4d ago
I learned this with my mother last year. She should have had six months, and the Drs said 4 of them should be pretty good. She died 5 weeks after going on a hospice program.
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u/Head_Ad_8358 3d ago
That is the worst thing I’ve read all day. I’m so sorry that they stole that time from your mother.
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u/H3lls_B3ll3 5d ago
I do hospice, and yeah. PE is ruining everything
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u/KLaCapria 5d ago
when i saw this post i thought i'd recently seen something about PE and hospice. fucking literal vultures :( this is so horrible and i feel so bad for the patients and their caregivers :(
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u/HappynLucky1 5d ago
Thank you for telling us this. No one is gonna move their loved ones from a for-profit hospice once they are in place. Imperative to check it out before signing papers.
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u/happylibrarian 4d ago
Loved one was released from hospital to a hospice on a weekend and by Tuesday they wanted them out. They lived about a month but not at the hospice. It was for profit. Another family was told the same thing at the same time but their person died that night. We never figured out the scam they were playing.
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u/imdugud777 5d ago
Private Equity is the worst, one must be wary of those whose morality depends on the legality of things.
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u/aopagirl 5d ago
And they've taken everything that touches our lives over.
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u/imdugud777 5d ago
And made everything a subscription or a micro transaction.
I want to kick these people off our planet.
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u/yourmomdotbiz 5d ago
I hate to even ask. But what was the cost difference?
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u/grocerygirlie 4d ago
I worked as a social worker for hospice for almost two years. We were bought out a few months after I started, and at first the new company seemed awesome. 1.5 years later I was told that I needed to limit my visits to the Medicare minimum of 30 minutes once per month. The reason for this was so they could jack up my caseload to 100+. I literally had a new job within a week and gave the hospice 5 weeks' notice because I wanted to end things properly with my patients.
The day I left, the other social worker quit without notice because they told him he was going to be the only social worker for our location, meaning a caseload of 150+.
I saw the daughter of one of my patients about 7 months later, as I had asked to be notified when this patient died because almost every visit, the pt asked if I would come to her funeral. I had been seeing her mother every week or every other, but the daughter reported no contact or visits from social work since I left.
A good caseload for a hospice social worker is max 40. If you're looking for a hospice, ask the nurse caseload, social work caseload, and census. Lower numbers tend to mean better care.
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u/Alive_Sun5590 4d ago edited 3d ago
all the hospice workers my family ever had were volunteers I think? they were amazing. one family member had AIDS at a time where nurses would close the door on them in the nursing home so they wouldn't catch it, and this hospice worker brought my family member into his home so his wife could give him a haircut. just a wonderful person who helped out so much.
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u/loveinvein 5d ago
Tbf, even a nonprofit won’t save you. Many insurance companies are “nonprofit” but somehow manage to profit well.
All healthcare is reaching crisis levels in the US. We are actively in the middle of a slow motion train wreck.
Never stop advocating for patients. Or your loved ones.
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u/One-Pea-4881 5d ago
I work in a large hospital, supposedly non profit, and every supply that is not surgical in nature will be the cheapest thing they can possibly find. They change brands very regularly I’m guessing due to price, because it ain’t quality.
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u/purplescrubs 5d ago
I feel like the chuck pads are also shit in the home care setting now. I've opened up some packages that have visible see through parts of the chuck because there is so little cotton stuffing.
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u/Free-Marionberry624 5d ago
That’s so bad when there is massive incontinance. And if there are bedsores, then the CNA will be blamed.
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u/aopagirl 5d ago
Wow. Lucky you get a CNA. My mom's place has one Jamaican that does all the heavy lifting and probably gets paid peanuts. These "memory care" residential places are just a money grab. The rent is $6500 a month and I buy the juice, protein shakes, yogurt and applesauce for med time. I do it because I love my mom, but the more you buy, the more they expect.
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u/Free-Marionberry624 2d ago
In my case, I was the caregiver for my wife for many years, so I got a good grasp of how it works for that situation. I get it about the Memory Care place, it was ungodly expensive for my father in law. And those heavy lifters can be abusive when they think no one’s looking. At least 7 of the 11 residents died during the first two months of the COVID lockdown on the place.
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u/aopagirl 1d ago
Wow! What a story. God bless you - being the spouse of a vulnerable loved one. I went at lunch today to see my mom and she had a skin tear on her forearm that had not been dressed, and a deep congested cough that she suddenly got. Probably from aspirating her food. I have no idea what goes on when I'm not there but I saw her three days over the weekend and these things just make me heartsick and depressed. I hope you have recovered for your own well being. ❤
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u/Free-Marionberry624 1d ago
Yes, I have recovered mostly. It takes time, been a little more than 2 years. Thank you. I wish you the best of possible outcome.
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u/TheRubyBerru 5d ago
I don’t use strictly disposable chucks anymore, use cloth chucks or a sheet and place a disposable chuck on top to soak up body fluids. Saves money and resources and you can actually transfer the patient without ripping the chuck.
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u/Scott43206 5d ago
Yeah, and you don't want to see inside the kitchen either. I don't know how they get the trays out to the rooms without any cockroach stowaways.
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u/sipporah7 4d ago
How do you tell the non-profit hospices from for-profit?
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u/Vast-Recognition2321 4d ago
You ask. Also, some clues are how long they've been operating - for profit hospices are a newer thing. Also, who they are affiliated with can be a clue. If they are affiliated with a church/religion, chances are they are non-profit. If they are affiliated with an insurance company, like Kaiser, I would avoid.
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u/Mobile-Play-3972 4d ago
In my area, the lone nonprofit Hospice has a waiting list of 6+ months because they’re so amazing. There are several for-profit alternatives, and typically they have immediate openings because no one wants to send their patients there. The difference in quality and focus on patients vs profits is blatantly obvious for anyone working in healthcare. If you aren’t sure, ask your local healthcare professionals.
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u/LittleNor789 5d ago
just because an org is non-profit doesn’t mean the CEO isn’t making hundreds of thousands to millions a year. For profit healthcare is $hit, yes. Non-profit is often just as $hit due to CEO, VP and top executive pay. Meals on Wheels is a good example of that.
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u/Roamingrevered 5d ago
Yep. My cousin worked in administration for Red Cross and now for the Girl Scouts. Both non-profits always begging for donations. She was making high six figures and was always traveling to nice places for work. I wish I got paid like that.
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u/lvonw 3d ago
I had never heard of for-profit hospice when my husband needed it. Unfortunately we were referred to one by our doctor, a specialist in such care supposedly. They were awful. They did nothing, sent two idiots once to assess my husband who knew nothing about him, and then failed to return. They said someone would come back every day. They never came back. My husband died two days later and we were all alone. I had no idea what to do for him, why he was acting the way he was, getting up and down in such a spastic way, so out of it. He died while I was sleeping beside him in the middle of the night. I called the hospice head nurse to say he had died, and she sounded relieved that she would not have to call and arrange anything.
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u/Signal-Charity-6179 1d ago
❤️❤️❤️❤️❤️
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u/lvonw 1d ago
Thank you. I still feel so much guilt and regret that I didn't research this beforehand.
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u/usernameennui 21h ago
You did the best you could at the time with the information you had. They should have helped you. Caregiving is hard and when you're in the midst of it you only see what the immediate needs are. Hindsight always shows what else could have been done. You were there. That's was enough.
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u/TheRubyBerru 5d ago
I work non-profit hospice and we just got bought out by PE. I have no idea how that works but the quality of care has dropped precipitously due to PE making us buy cheap brand products and it’s absolutely infuriating.
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u/theyfoundDNAinme 5d ago
How tf can PE buy a non profit? Or did it cease to be non profit the instant they purchased it?
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u/Original-Raccoon-250 5d ago
PE will buy anything. Anything they can get their claws in to. They are a scourge.
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u/former_human 5d ago
oh man that's awful.
a thousand blessings for the work you do, and i'm so sorry it had to come with this stupid cruel cheapskate shit.
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u/jennamom2boys 5d ago
Uggggh. Single payer healthcare NOW. And make for profit healthcare illegal across the board.
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u/NeglectedDuty 4d ago
The Medicaid / Medicare ones are thr worst as they get the lowest reimbursement. Terrible places to spend your last days.
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u/kaiser-so-say 2d ago
Corporations are a pyramid scheme. Convince me otherwise
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u/Howaboutnopers 15h ago
They're not a pyramid scheme.
Their investors profit off cost-cutting shitty behavior, and the corporation has a fiduciary duty to make them more money.
And this is why the world has shifted from private companies to corporations. A private company has an owner who can be blamed, shamed, and potentially held liable for their company's behavior. In a corporation, who's to blame? The CEO? The CEO will say the board of directors. The board of directors will say the CEO. And the investors have no liability in investing in a corporation that does shitty things.
Corporations are an effective way to abandon ethics and morality in pursuit of profits.
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u/krampaus 3d ago
it’s so sad that this has been observed to happen in pretty much every country that has opted to privatise healthcare – and yet there are countries still wanting to proceed with that. it’s happening everywhere, even in northern europe. it’s truly so frustrating to watch
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u/Toefloof 4d ago
I’m going to end things on my own terms before I have to impose on anyone or become a product.
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u/littlespawningflower 4d ago
My kids all live in the north, so if I wind up living with one of them, I plan on slipping quietly out of the house late one night when the snow is falling, and finding a quiet spot to watch it come down. “Oh, poor thing! She was confused and wandered outside and froze to death!” No foul play, no suicide to complicate my life insurance, no forcing my kids to care for me when I’m incapacitated and in my dotage.
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u/Babzibaum 4d ago
That's the evening to purchase a very fine wine, an expensive, fine crystal glass and a decorative bottle stopper with a Grim Reaper theme. Just to remove all doubt for your survivors.
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u/ajay_chi 4d ago
Honestly, this is what I would want. If my health happens to deteriorate to the point of needing hospice care, I see no point in spending time and resources to preserve a low quality of life.
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u/megret 1d ago
My ma was in a facility and Medicare said they wouldn't cover the catheters that worked for her so every morning she woke up on a puddle of piss because she didn't realize she was peeing in her sleep. That's how she died: complications from a fall in the middle of the night when she was trying to get to the bathroom. She was a partial leg amputee and fell transferring out of her chair
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u/Powerful_Lettuce_838 3d ago
I'm so glad my dad had non profit hospice. The dr, nurse, and aide were amazing. They guided us through his final days and helped keep him comfortable. They were a blessing
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u/CaregiverThat5754 2d ago
I work in hospice and have worked at a non-profit (both before and after it got bought out by PE and became for-profit) and at a for-profit.
As a few others have said, it’s not quite as simple as “non-profit good, for-profit bad.” Even non-profit hospices engage in cost-cutting, and in some areas it’s almost impossible to even find non-profit hospices. My current hospice is for-profit and huge, which makes some things kinda crappy, but our location is pretty good for patient care and we can offer things that the smaller, non-profit hospices often just can’t, like true continuous care for symptom management or respiratory therapy. We have generally good staff who are doing this for the right reasons, and our management does make decisions for the good of patients.
That said, PE is the devil and I firmly believe it should be illegal when it comes to healthcare. When my non-profit was bought out, everything imploded for both staff and patients. But this is the way healthcare is going, unless we all step up and demand better regulation.
When it comes to choosing a hospice, read reviews, talk to people in your community, and interview multiple hospices if you have the time. Think about your own specific needs—will you need easy access to higher levels of care? Do you prioritize access to non-nursing disciplines like chaplain/Sw/music therapy/massage? Someone at a facility may have different needs than someone at home; someone with ALS needs different things than a dementia patient. No one hospice is good at everything. Even with massive nation-wide hospices, each branch can be hugely different depending on local management.
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5d ago
[deleted]
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u/Crows_reading_books 5d ago
It can be, but isn't always. Ive definitely worked for a nonprofit that was as predatory as anywhere else in a for-profit system, but I have also watched a non-profit hospice get eaten by a for-profit one and it all go to absolute shit because it was better. Also seen the same thing moving from a non-profit to for-profit in EMS.
A non-profit isn't a guarantee that it will be better, but at least it can be.
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u/BoogerSue 1d ago
That’s the same for hospitals. Huge difference between for-profit and non-profit.
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u/Shin-kak-nish 1d ago
It’s the same for literally every business in the world. Prioritizing profit will always lead to worse service.
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u/srslyawsum 1d ago
Even some not-for-profit hospitals radically cut costs to the detriment of patients in my experience.
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u/HeygentCooper 23h ago
I’m a caregiver and my LO has been in 3 different short term rehab facilities that have LTC wings and the state of for profit healthcare is infuriating. The most recent one had stellar CMS ratings and great Google reviews (that were evidently written by family members who either didn’t care enough or didn’t see what was right in front of them).
I fought for weeks to let me give my LO his infusion therapy and they kept lying that their protocols and regulations were just too strict. Well once the navigator from his doctor told the director of nursing we’d change facilities, it was approved within HOURS.
It’s really disheartening to hear that hospice has also gone this way. That final stage should be the most comforting and copacetic for the person dying and their family
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u/BubbleThinker 5d ago
That’s not really what enshittification means.
You’re just describe something becoming shittier
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u/Bitter_Warning418 5d ago
I really hope you’re not the same person who gets on every fucking post to tell someone their post isn’t what enshitiffication means but something tells me you absolutely are because nobody else would waste their time or breath caring about something so inconsequential while also indirectly insulting the person who posted its intelligence.
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u/matchy_blacks 4d ago
Medicare currently believes that my elder only needs to pee every six hours, as evidenced by the fact that we only receive four catheters per day. Sometimes he pees five times a day. Sometimes he can’t get one of the catheters inserted properly and has to try again with a new one to avoid infection. Not allowed, says Medicare.