Death and Profits

When Hugh Westbrook pioneered hospice care, his organization saw to the needs of the dying. Fifteen years later nothing has changed -- except the politics and the profit margins.

The principal criticisms leveled at Westbrook are generally framed in philosophical terms and arise from the fact that his hospices, unlike nearly all others, are profit-making ventures. Typical is that offered by Bernice Wilson, executive director of the Ohio Hospice Organization: "The notion of making money off of terminally ill people is what almost reflexively is tough for a lot of the public, and it is particularly tough with people in the hospice movement."

"Hospice is very much a mission, a calling," says Larry Beresford, author of The Hospice Handbook. "The patients that are cared for are dying, and this is a very special time in their life, so what we do has a very powerful, emotional connection to the patients. And doing this for profit just sort of rubs people the wrong way."

"It is difficult to serve two masters," adds Audrey Gordon, a chaplain and hospice expert who helped form several nonprofit hospices in Chicago and who is also a professor at the University of Illinois School of Public Health. "If one of your masters is your investors, you can't properly serve your other master: your patient. The top three concerns, at all times, have to be the patient and their family, the patient and their family, the patient and their family. And if you are for-profit, those can't be your top three concerns."

Westbrook brushes off such reproaches. "I hope this company gets much larger than it is," he says emphatically, "because I hope there is a time in which anybody who is terminally ill will have access to a hospice program that is as good as ours. It is one of the greatest social-reform movements that has happened in the last ten years A very quietly, very low key. We make a difference in the way people die."

As for the queasiness many people feel at the thought of profiting from those who are dying, Westbrook is confidently self-assured. "I make no apology about it at all," he says. "I did not get into this for a profit motive. Our company is not run with a profit motive. The company has a mission, and we make enough money to pay our bills and to keep the investors interested. And that's the way it ought to be."

Westbrook weathered the federal investigation and dismisses the criticism from his nonprofit colleagues. And while doing so, he has prospered. Last year, for example, his hospices in Miami, Fort Lauderdale, Dallas, Houston, Fort Worth, Chicago, and Cincinnati served nearly 15,000 patients and generated revenues estimated at $130 million. Those figures are far higher than any other hospice corporation in the nation, 96 percent of which are nonprofit. One out of every ten terminally ill patients in a hospice today is being cared for by Westbrook's company, which is scheduled to open a Philadelphia branch in the next few weeks. More expansion can be expected, though Westbrook will not discuss his plans in detail.

Indeed the hospice industry as a whole has reason to be optimistic about the future, even in the highly charged atmosphere of the national health-care debate. According to figures provided by the Congressional Budget Office, total expenditures for hospice care have risen from two milliondollars in 1984 to a projected $920 million by 1994. In Florida, which has the highest percentage of elderly people of any state in the nation, Westbrook's share of that lucrative market is assured. His friends in the state legislature granted him a monopoly in Dade and Broward counties. Hugh Westbrook and Hugh Westbrook alone is permitted by law to operate profit-making hospices in South Florida.

Fisher Island may seem like a ritzy place to start what at the time was exclusively a nonprofit movement, but in 1977 it was merely an island where the University of Miami had a few teaching facilities and not a whole lot more. Reverend Westbrook and Esther Colliflower, an educator, were there to attend a mental health conference. The two had been teaching a class on issues related to death and dying at Miami Dade Community College and thought the conference would be a good place to float their idea for a hospice program.

"Esther and I put a sign up on a tree," Westbrook recalls. "It said that if you were interested in starting a program to actually take care of terminally ill people, then meet here at 2:00 p.m."

Of the 200 people who were attending the conference, only about 30 joined the minister and the nurse at the appointed hour. "We all sat down under that tree," Westbrook continues, "and Esther and I told them, 'Look, we're probably not great teachers, we're certainly not great researchers and writers, but we think we can put together a program here that will actually take care of dying people.'"

That group of 30 shrunk to a core group of six, who met every week for six months. "We really didn't even know what a hospice was back then," the minister says, "but by 1978 we were taking care of patients. Out of the original group, Esther and I ended up being the people who stuck with it."

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