Poppy Alexander and her mother enjoy time together.

This is my first Mother’s Day after my mother’s death in December. Before she died, she suffered for years from Alzheimer’s, a disease that came on slowly then quickly, transforming my warm, quick-witted mother from the beating heart of any gathering to a withdrawn and occasionally angry presence. She eventually came to require a level of care that our family was unable to provide her at home and spent the last years of her life in a memory care facility – an ever-increasing reality for families.

As we sat with her in her new home, we learned that memory care facilities are their own little worlds. My mother had a relationship with the staff and residents that was wholly her own, a different kind of familial setting. One staff member always played her ‘These Boots Are Made for Walking’ while getting her ready for bed. Others would pop their head in, knowing her history as one of the authors of the groundbreaking women’s health treatise, Our Bodies, Ourselves. My mother’s roommate, a former dancer with long gray hair that matched hers, became her best friend, with the two of them staying up all night chatting in a language only they could understand. This intimate warmth was a crucial part of keeping my mother as happy and calm as she could reasonably be, given her disease.

Then, in September 2024, my mother fell and broke her hip, precipitating a decline that put her into hospice care. The hospice my mother entered in September 2024 was a locally managed non-profit. But by the time of her death in December, the hospice service had agreed to a joint venture arrangement with an out of state private equity company.

My mother’s hospice reflects a much larger, and ever-growing, trend. In the last 10 years, private equity spent $1 trillion buying up healthcare facilities—and often facilities that support the most vulnerable patients, including hospice. Medicare covers most hospice care in the U.S. Medicare spent $23.7 billion on hospice benefits in 2022. Private equity is taking note, with an explosion of new for-profit hospice companies, mostly owned by private equity, not healthcare companies at all. While the number of non-profit hospice providers has shrunk slightly (from 1,245 in 2018 to 1,169), the overall number of hospice providers has grown enormously—almost 30% from 2018 to 2022. That growth is entirely due to more for-profit companies rushing into the space, mostly private equity firms focused on profit, not care.

We didn’t think much about this impending ownership change at the time because hospice for us was so personal, largely centered around the individuals who managed my mother’s care. The assigned nurse was everything you could ask for, a seemingly impossible blend of compassion and competence. She made what is an obviously difficult process so much easier with her warmth and generous use of her time. She let me pepper her with questions about the complex brain changes my mother was experiencing and the minutiae of her care. She got to know the rotating cast of friends who crowded into my mother’s small room, perched on the available wheelchairs and seats, and answered their questions with the same patience and detail.

In addition, we had the support of a spiritual leader and a social worker. We had a ready number to call for all needs. We had someone paying close attention at all times to my mother’s care and an identifiable set of unique faces to make regular and lengthy visits. The whole experience of her last months of life would have been entirely different but for the true love and care provided by a hospice grounded in the community.

In the course of the staff’s care work, we heard rumblings about the private equity sale. Staff voiced concerns that it would mean they’d be expected to maintain larger patient loads, spend less time with patients, and generally do more with less. Sadly, their fears are not ungrounded. We already know the private equity playbook from other healthcare arenas, such as drug rehabilitation centers, hospitals, and, yes, memory care facilities like my mother’s: understaff and overdemand, squeeze every dollar out of government insurers, while leaving patient care as a secondary concern. This profit-focused strategy has already begun to affect hospice care more broadly, with private equity blamed as the primary driver of lowering the quality of care. This growing problem is leading some states, such as Massachusetts, to create innovative accountability mechanisms, including potential liability for “significant investors” in healthcare companies under the state’s False Claims Act. Other state authorities are explicitly looking at the added risks in hospice care, including pausing the consummation of the joint venture deals like this one, citing concerns from hospice staff about the potential decline in patient care.

I am, of course, not only a daughter. I am also a fraud attorney here at Whistleblower Partners, representing whistleblowers who report corporate fraud to the government. A significant portion of our business concerns healthcare fraud. Unfortunately for all of us, too many companies see Medicare spending as open season for profit—and sometimes without regard to legal restraints. With the growing number of profit-driven hospice companies, we are seeing an equally growing number of hospice fraud cases, including at least two different settlements in the last year. The fundamental disconnect in the uniquely American idea that healthcare can be a profit-maker seems all the more stark when you’re talking about the business of dying. My mother may not have lived long enough to feel the consequences of a profit motivation, but I know that every family deserves the care we received to the end.

Our final days in my mother’s room were filled with music, laughter, stories, and love—and not just from our family and friends. The hospice staff were right there with us, enjoying getting to know my mother’s history, learning the nuances of our family dynamics, helping all of us get through this transition and into the next stage. When my mother passed, our hospice nurse cried along with us and hugged us. And then she carefully and respectfully washed and cared for my mother’s body, as if she were her own family. The intimate relationship we had formed with a woman who had been a stranger months earlier was breathtaking in so many ways, and so critical for my mother’s exit from this world.

Shareholders’ value should not be determining what care a person gets at any stage of their life. We here at Whistleblower Partners fight every day to make sure money-seeking companies cannot bypass the rules set up to protect us from companies willing to bend the law in the name of profits. On this Mother’s Day, I wish for a very different outcome for everyone’s mother. My mother – and yours – deserve better than that.