Caregiver and Employee Experience Among Big Hospices—Ranking of the Largest US Hospices by Three Quality Indicators

Abstract

Background Several studies chronicle profit-making negatively impacting US hospice care quality. However, no study has reported on caregiver satisfaction expressed online by hospice. Objectives Assess the relationship between online caregiver sentiment, market share, profit status, and Consumer Assessment of Healthcare Providers and Systems (CAHPS®) scores among the 50 largest US hospices. Methods Retrospective mixed methods of sentiment and multivariate regression analysis. Data sources were online caregiver reviews, provider CAHPS hospice survey data. Results Being a larger, for-profit predicted diminished caregiver and employee satisfaction. Caregiver Sentiment and CAHPS Composite were so highly associated ( r = .862, P < .001), that they are converging on overall caregiver satisfaction. With large effect, CAHPS Star Rating was significantly higher than Review Star Rating. For-profits had significantly higher overall Emotional Intensity than non-profit hospices, again with large effect. Caregiver Sentiment, Review Star Rating, and Glassdoor Composite each predicted CAHPS Composite. Lack of staffing was more frequent among for-profits (13%) than non-profits (6%). Out-of-scope expectations prevalence was 9%. Conclusion Caregiver and employees had better experiences with non-profits than for-profits. Anger and frustration was expressed toward large, for-profit providers more focused on admissions, profiteering, and paying dividends than actual care. The CAHPS appears to draw more satisfied caregivers. Whereas, online reviewing provides open-ended, real-time voicing of care quality concerns. Even with distinct methods, CAHPS survey and review sentiment analysis converge on caregiver satisfaction, yet CAHPS paints a much rosier picture of hospice quality than online reviews. Future research should explore sentiments by topic and hospice to increase customer advocacy.