{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,30]],"date-time":"2026-10-30T10:38:15Z","timestamp":1793356695107,"version":"4.5.0"},"reference-count":46,"publisher":"SAGE Publications","license":[{"start":{"date-parts":[[2026,7,28]],"date-time":"2026-07-28T00:00:00Z","timestamp":1785196800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"},{"start":{"date-parts":[[2026,7,28]],"date-time":"2026-07-28T00:00:00Z","timestamp":1785196800000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"funder":[{"DOI":"10.13039\/100000056","name":"National Institute of Nursing Research","doi-asserted-by":"publisher","award":["R01NR020601"],"award-info":[{"award-number":["R01NR020601"]}],"id":[{"id":"10.13039\/100000056","id-type":"DOI","asserted-by":"publisher"}]},{"name":"Patrick and Catherine Weldon Donaghue Medical Research Foundation","award":["DF_10.15.25"],"award-info":[{"award-number":["DF_10.15.25"]}],"id":[{"id":"https:\/\/ror.org\/02mvkbz85","id-type":"ROR","asserted-by":"crossref"}]}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Am J Hosp Palliat Care"],"abstract":"<jats:p>Hospice care is associated with improved end-of-life outcomes. Recent shifts in hospice utilization highlight several key trends. Alzheimer\u2019s disease and related dementias (ADRD) (25%) have surpassed cancer (23%) as the leading primary diagnosis. Concurrently, industry ownership has transitioned from predominantly nonprofit to for-profit (70%) and private equity (PE) ownership has grown dramatically from 3% to 15%. To date, no study has synthesized evidence on PE ownership in hospice care. We conducted a systematic review of English-language, peer-reviewed studies published 2012-2026, following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Of 630 screened articles, 114 underwent full-text review and 6 met inclusion criteria. All studies used national data; sample sizes ranged from 80 to 536 PE-owned hospices. Three studies examined PE prevalence and market trends; two assessed caregiver-reported care experiences, and one evaluated financial outcomes by PE ownership. The evidence regarding PE ownership of hospices remains limited. It highlights the increasing role of PE in hospice markets. It consistently found (across two studies) worse care experiences at PE-owned hospices vs nonprofit hospices, except for emotional and religious support which was similar across ownership type. The evidence suggests PE ownership is associated with complex, often worse patterns related to market structure, care experiences, and financial allocation. Additionally, it underscores the limited evidence base to inform policy development. Research is needed to examine associations between PE ownership and hospice care quality, both overall and among vulnerable populations. Research should clarify modifiable factors influencing hospice quality and better characterize evolving ownership structures.<\/jats:p>","DOI":"10.1177\/10499091261471107","type":"journal-article","created":{"date-parts":[[2026,7,29]],"date-time":"2026-07-29T04:13:38Z","timestamp":1785298418000},"update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":1,"title":["Private Equity Ownership in Hospice Care: A Systematic Review (2012-2026)"],"prefix":"10.1177","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-3815-908X","authenticated-orcid":false,"given":"Denise D.","family":"Quigley","sequence":"first","affiliation":[{"name":"RAND Corporation"},{"name":"RAND School of Public Policy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shannon","family":"Walsh","sequence":"additional","affiliation":[{"name":"RAND School of Public Policy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cordt T.","family":"Kassner","sequence":"additional","affiliation":[{"name":"Hospice Analytics"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lara","family":"Dhingra","sequence":"additional","affiliation":[{"name":"MJHS Institute for Innovation"},{"name":"Albert Einstein College of Medicine"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrew W.","family":"Dick","sequence":"additional","affiliation":[{"name":"RAND Corporation"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2026,7,28]]},"reference":[{"key":"e_1_3_7_2_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijnurstu.2010.08.003"},{"key":"e_1_3_7_3_2","doi-asserted-by":"publisher","DOI":"10.1089\/jpm.2018.0431"},{"key":"e_1_3_7_4_2","volume-title":"Oxford Textbook of Palliative Medicine. Sixth Edition","author":"Portenoy R","year":"2021","unstructured":"Portenoy R, Currow D. Oxford Textbook of Palliative Medicine. Sixth Edition. Oxford University Press; 2021."},{"key":"e_1_3_7_5_2","doi-asserted-by":"publisher","DOI":"10.1089\/jpm.2017.0548"},{"key":"e_1_3_7_6_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jpainsymman.2005.04.013"},{"key":"e_1_3_7_7_2","volume-title":"Dying in America: Improving Quality and Honoring Individual Preferences near the End of Life","author":"Institute of Medicine","year":"2015","unstructured":"Institute of Medicine. Dying in America: Improving Quality and Honoring Individual Preferences near the End of Life. Accessed July 1, 2024;2015."},{"key":"e_1_3_7_8_2","volume-title":"The National Imperative to Improve Nursing Home Quality: Honoring Our Commitment to Residents, Families, and Staff","author":"National Academies of Sciences E, and Medicine","year":"2022","unstructured":"National Academies of Sciences E, and Medicine. The National Imperative to Improve Nursing Home Quality: Honoring Our Commitment to Residents, Families, and Staff. Accessed July 1, 2024;2022."},{"key":"e_1_3_7_9_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jpainsymman.2021.12.013"},{"key":"e_1_3_7_10_2","volume-title":"Report to the Congress: Medicare Payment Policy","author":"Medicare Payment Advisory Commission","year":"2026","unstructured":"Medicare Payment Advisory Commission. Report to the Congress: Medicare Payment Policy; 2026."},{"key":"e_1_3_7_11_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jamda.2022.03.010"},{"key":"e_1_3_7_12_2","doi-asserted-by":"publisher","DOI":"10.1111\/jgs.16361"},{"key":"e_1_3_7_13_2","doi-asserted-by":"publisher","DOI":"10.1177\/1049909120931468"},{"key":"e_1_3_7_14_2","doi-asserted-by":"publisher","DOI":"10.1177\/10499091251313761"},{"key":"e_1_3_7_15_2","doi-asserted-by":"publisher","DOI":"10.1080\/08959420.2023.2286164"},{"key":"e_1_3_7_16_2","volume-title":"Older Adults Outnumber Children in 11 States and Nearly Half of","author":"United States Census Bureau","year":"2025","unstructured":"United States Census Bureau. Older Adults Outnumber Children in 11 States and Nearly Half of. U.S. Counties; 2025."},{"key":"e_1_3_7_17_2","volume-title":"Report to the Congress: Medicare and the Health Care Delivery System","author":"Medicare Payment and Advisory Commission (MedPAC)","year":"2025","unstructured":"Medicare Payment and Advisory Commission (MedPAC). Report to the Congress: Medicare and the Health Care Delivery System; 2025."},{"key":"e_1_3_7_18_2","volume-title":"Hospice News Provider Rankings and Annual Trends Report","author":"Hospice News 50","year":"2025","unstructured":"Hospice News 50. Hospice News Provider Rankings and Annual Trends Report; 2025."},{"key":"e_1_3_7_19_2","doi-asserted-by":"publisher","DOI":"10.1136\/bmj-2023-075244"},{"key":"e_1_3_7_20_2","doi-asserted-by":"publisher","DOI":"10.1001\/jamainternmed.2020.6262"},{"key":"e_1_3_7_21_2","doi-asserted-by":"publisher","DOI":"10.1089\/jpm.2024.0269"},{"key":"e_1_3_7_22_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jamda.2025.105578"},{"key":"e_1_3_7_23_2","doi-asserted-by":"publisher","DOI":"10.1001\/jamanetworkopen.2023.34582"},{"key":"e_1_3_7_24_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.rec.2021.07.010"},{"key":"e_1_3_7_25_2","volume-title":"Critical Appraisal Tools","author":"JBI","unstructured":"JBI. Critical Appraisal Tools. JBI. https:\/\/jbi.global\/critical-appraisal-tools"},{"key":"e_1_3_7_26_2","volume-title":"JBI Manual for Evidence Synthesis","author":"Moola S","year":"2020","unstructured":"Moola S, Munn Z, Tufanaru C, et al. Chapter 7: systematic review of etiology and risk. In: Aromataris E, Munn Z, eds. JBI Manual for Evidence Synthesis. JBI; 2020."},{"key":"e_1_3_7_27_2","volume-title":"Long-term care: funding of long-term care","author":"Seiler LW","year":"2015","unstructured":"Seiler LW, Fleming JA, Thomson Reuters A. Long-term care: funding of long-term care. Issue Brief Health Policy Track Serv; 2015."},{"key":"e_1_3_7_28_2","doi-asserted-by":"publisher","DOI":"10.1377\/hlthaff.2023.01671"},{"key":"e_1_3_7_29_2","doi-asserted-by":"publisher","DOI":"10.1377\/hlthaff.2025.00327"},{"key":"e_1_3_7_30_2","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2024.20546"},{"key":"e_1_3_7_31_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.socscimed.2026.119113"},{"key":"e_1_3_7_32_2","unstructured":"Irving Levin Associates LLC. Acquisitions intelligence. Irving levin associates LLC. https:\/\/www.levinassociates.com\/"},{"key":"e_1_3_7_33_2","unstructured":"Refinitiv. Refinitiv eikon. Refinitiv. Accessed May 6 2026.https:\/\/eikon.refinitiv.com\/"},{"key":"e_1_3_7_34_2","volume-title":"S&P Capital IQ Pro","author":"S&P Global","unstructured":"S&P Global. S&P Capital IQ Pro. Accessed May 6, 2026.S&P Global. https:\/\/www.spglobal.com\/market-intelligence\/en\/solutions\/products\/sp-capital-iq-pro"},{"key":"e_1_3_7_35_2","unstructured":"PitchBook. Empowering the evolving private market ecosystem. PitchBook. Accessed May 6 2026.https:\/\/pitchbook.com\/"},{"key":"e_1_3_7_36_2","unstructured":"Mergr. Private equity and M&A database Accessed May 6 2026.https:\/\/mergr.com\/"},{"key":"e_1_3_7_37_2","unstructured":"Centers for Medicare and Medicaid Services. The provider reimbursement manual\u2014part 2 provider cost reporting forms and instructions. Chapter 43-(T7) hospice cost report (Form CMS-1984-14). Centers for Medicare and Medicaid services. https:\/\/www.cms.gov\/regulations-and-guidance\/guidance\/manuals\/paper-basedmanuals-items\/cms021935"},{"key":"e_1_3_7_38_2","volume-title":"Hospice Compare Website","author":"Centers for Medicare & Medicaid Services","unstructured":"Centers for Medicare & Medicaid Services. Hospice Compare Website. Centers for Medicare & Medicaid Services. https:\/\/www.cms.gov\/newsroom\/fact-sheets\/hospice-compare-website"},{"key":"e_1_3_7_39_2","volume-title":"CAHPS\u00ae Hospice Survey","author":"Centers for Medicare & Medicaid Services","unstructured":"Centers for Medicare & Medicaid Services. CAHPS\u00ae Hospice Survey. Centers for Medicare & Medicaid Services. https:\/\/www.cms.gov\/medicare\/quality\/hospice\/cahpsr-hospice-survey"},{"key":"e_1_3_7_40_2","doi-asserted-by":"publisher","DOI":"10.1111\/1475-6773.12828"},{"key":"e_1_3_7_41_2","doi-asserted-by":"publisher","DOI":"10.1377\/hlthaff.2022.00308"},{"key":"e_1_3_7_42_2","doi-asserted-by":"publisher","DOI":"10.1001\/jamahealthforum.2021.3817"},{"key":"e_1_3_7_43_2","doi-asserted-by":"publisher","DOI":"10.1001\/archinternmed.2007.36"},{"key":"e_1_3_7_44_2","doi-asserted-by":"publisher","DOI":"10.1177\/0046958017742761"},{"key":"e_1_3_7_45_2","doi-asserted-by":"publisher","DOI":"10.1377\/hlthaff.2020.01535"},{"key":"e_1_3_7_46_2","doi-asserted-by":"publisher","DOI":"10.1001\/jamainternmed.2020.3552"},{"key":"e_1_3_7_47_2","doi-asserted-by":"publisher","DOI":"10.7326\/M20-1361"}],"container-title":["American Journal of Hospice and Palliative Medicine\u00ae"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/10499091261471107","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/full-xml\/10.1177\/10499091261471107","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/10499091261471107","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,10,30]],"date-time":"2026-10-30T09:45:08Z","timestamp":1793353508000},"score":1,"resource":{"primary":{"URL":"https:\/\/journals.sagepub.com\/doi\/10.1177\/10499091261471107"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,7,28]]},"references-count":46,"alternative-id":["10.1177\/10499091261471107"],"URL":"https:\/\/doi.org\/10.1177\/10499091261471107","relation":{},"ISSN":["1049-9091","1938-2715"],"issn-type":[{"value":"1049-9091","type":"print"},{"value":"1938-2715","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,7,28]]},"article-number":"10499091261471107"}}