EPISODE · Nov 12, 2025 · 27 MIN
How Hospice Care Has Changed and Why It Matters: Fran Smith, Co-author of Changing the Way We Die
from WorkforceRx · host Futuro Health
Hospice care in the US has undergone major shifts in recent years, with a significant jump in usage and a 400% increase in private equity ownership as major factors driving it to become the most profitable subsector in healthcare, according to a 2023 RAND Corporation study. To understand these trends what they mean for healthcare workers, patients and families, we turn to Fran Smith, co-author of Changing the Way We Die: Compassionate End of Life Care and the Hospice Movement, an Amazon bestseller. As she explains to Futuro Health CEO Van Ton-Quinlivan, what started as a non-profit, mission-driven movement has evolved into an industry dominated by for-profit entities -- including a growing percentage backed by private equity -- with major implications for quality and consistency of care. “There is some data showing that staffing is poor at privately owned and private equity hospices compared to nonprofits, and that the for-profit hospice companies use more licensed practical nurses than registered nurses,” she explains. And while Smith believes it’s better for there to be a mix of business models in the sector, she does advise that people seeking hospice care evaluate their options using tools on the medicare.gov website, and by asking providers in their circle about the reputation of various organizations. This super informative episode of WorkforceRx also provides advice on when and how to talk to loved ones about end-of-life wishes, and a takes look at the future of this crucially important type of healthcare.
What this episode covers
Hospice care in the US has undergone major shifts in recent years, with a significant jump in usage and a 400% increase in private equity ownership as major factors driving it to become the most profitable subsector in healthcare, according to a 2023 RAND Corporation study. To understand these trends what they mean for healthcare workers, patients and families, we turn to Fran Smith, co-author of Changing the Way We Die: Compassionate End of Life Care and the Hospice Movement, an Amazon bestseller. As she explains to Futuro Health CEO Van Ton-Quinlivan, what started as a non-profit, mission-driven movement has evolved into an industry dominated by for-profit entities -- including a growing percentage backed by private equity -- with major implications for quality and consistency of care. “There is some data showing that staffing is poor at privately owned and private equity hospices compared to nonprofits, and that the for-profit hospice companies use more licensed practical nurses than registered nurses,” she explains. And while Smith believes it’s better for there to be a mix of business models in the sector, she does advise that people seeking hospice care evaluate their options using tools on the medicare.gov website, and by asking providers in their circle about the reputation of various organizations. This super informative episode of WorkforceRx also provides advice on when and how to talk to loved ones about end-of-life wishes, and a takes look at the future of this crucially important type of healthcare.
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How Hospice Care Has Changed and Why It Matters: Fran Smith, Co-author of Changing the Way We Die
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