The U.S. hospice movement has proved enormously successful, growing from one hospice in 1974 to around 6100 hospices serving some 1.6 million clients annually. With that success, however, have come changes. Whereas the original hospices were independent, freestanding institutions, these days most hospice care is received in homes and nursing homes. In addition, the original hospices were nonprofit organizations that were primarily staffed by volunteers and emphasized individualized care and patient participation. Now that hospices are primarily funded by insurers, they have had to reconfigure their staffing and practices to meet standards for care based on hospital protocols. Finally, around two-thirds of all hospices are now run on a for-profit basis. For profit hospices are less likely than other hospices to provide care at home and are more likely to declare clients ineligible for services even as they get closer to death, apparently to reduce their costs and increase their profits.
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