Ep. 356 What Keeps Me Up at Night (about Hospice and Palliative Care) with Ira Byock MD

Dr. Ira Byock takes an honest and challenging look at worrisome issues within the hospice and palliative care field.

My guest today is Dr. Ira Byock who is a leading palliative care physician, author, and public advocate for improving care through the end of life. He is the Founder and Chief Medical Officer for the Institute for Human Caring of Providence St. Joseph Health. He is a frequent guest on this podcast and the author of Dying Well, The Four Things that Matter Most, and The Best Care Possible. Today he shares some of the concerns he has about current issues in hospice and palliative care. Learn more about his books and his work at the website:


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This episode includes:

  • The history of hospice programs and how and why they began
  • For-profit hospices now outnumber non-profit hospices by nearly 3 to 1
  • Problems with for-profit hospices include poor staffing, patients are less likely to see a doctor or social worker, 10% fewer nursing visits
  • For-profits extract up to 20% margin from patient care and make it hard for non-profits to stay in business
  • Concerns about sending patients home for hospice care without providing training to family members
  • Staff are burning out because of moral distress and because of excessive case loads which are being imposed for the sake of profit
  • For-profit hospices are being traded on Wall Street and private equity firms are also buying up hospices
  • How a focus on marketing and “branding” is causing palliative care to distance itself from hospice and from death and dying
  • Why we have to be brave enough to talk about and deal with the things that people in our society are afraid of
  • Why the palliative care “brand” should be providing the best care possible through the end of life (instead of “at the end of life”)
  • What to do:
    • Don’t trust blindly – ask questions and be discerning
    • Don’t lose your outrage – speak up when you see poor care being given
    • Be strong advocates for one another
    • Support community-based non-profit hospices

Links mentioned in this episode:

  • Pre-order All the Flowers of the Mountain by Christina Holbrook here (and thank you!)

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