Months after uproar over potential sale, Nashville’s Alive Hospice CEO talks about the future

Community and volunteer group have “common goals” after the sale was scrapped, as hospice remains nonprofit

By: - September 5, 2023 6:00 am
A security guard stands outside Alive Hospice in Nashville, Tenn. (Photo: John Partipilo)

A security guard stands outside Alive Hospice in Nashville, Tenn. (Photo: John Partipilo)

Nearly three months ago, Nashville’s Alive Hospice board announced it would remain a nonprofit, independent organization that for nearly 48 years has cared for people at the end of their lives, a move that capped months of controversy after news broke that Alive might sell to a for-profit entity. 

A group called Keep Alive Alive formed  to publicly urge the hospice to stay nonprofit, while Alive’s board reiterated its support of the hospice’s mission and said it was committed to acting only in Alive’s best interest.

By early June, Alive’s board announced it would remain independent and nonprofit. Its chief executive officer stepped down and an interim CEO was appointed from within the organization. 

“The community wants the same thing we want,” said Joseph Hampe, Alive Hospice’s chief operating officer and interim CEO. “It’s time to stop hashing what happened three months ago” and work toward common goals, said Hampe, who joined the nonprofit in 2012.

Discussion of Alive’s future comes at a time when roughly seven in 10 hospices nationwide are operated by for-profit entities. Most hospices were nonprofits when the hospice movement first began in the U.S. some 50 years ago. Medicare, the federal program that provides health insurance coverage to Americans age 65 and older, started to offer a hospice-care benefit in 1983. Since then, the number and percentage of for-profit hospices has burgeoned.

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In Tennessee, the cradle of for-profit healthcare, 48 out of 66 hospices listed by the Tennessee Hospice and Palliative Care Organization are run by for-profit organizations. In Nashville, Alive is the only nonprofit among eight hospices. 

Hampe said the task now for Alive and its board is to determine “how to stay independent and stay in this space.” The mission of a hospice CEO, particularly Alive’s CEO, he said, is to “protect the mission of Alive, to make sure we are doing the right thing moving forward to protect the community,” so that Alive Hospice can continue to provide services “that others can’t do.” 

Those services, Hampe said, include providing grief support to people throughout Middle Tennessee, regardless of whether their families previously turned to Alive for hospice services. Alive also provides about $1.2 million to $1.6 million in charity care each year, he said.

“In my 12 years (Alive has) never turned away” someone needing services who could not pay, he said. “Everyone deserves dignity at the time of death, regardless of socioeconomic status.”

All hospices face similar challenges, Hampe said. “Here at Alive we sit in the shadow of Vanderbilt and HCA and Ascension” and compete for staff with those major healthcare providers, he says. 

Medicare regulations and reimbursement rates are constantly changing, the healthcare sector is rapidly consolidating and new providers are opening hospices, he said. Alive must make sure it stays innovative and flexible to new ideas. 

Alive Board Chair Vicki Estrin said that for at least the last 10 years, Alive has been approached by organizations with various business propositions and approaches to do business together.

Alive Hospice CEO steps down after pushback over rumored sale to for-profit health provider

“In general, when a nonprofit board is faced with a business proposal—including a proposal from an outside for-profit organization to buy control … the board members typically look into/at that proposal to determine whether it may be in the best interest of the nonprofit to pursue it, since an ordinarily prudent person would look into that kind of proposal rather than ignore or reject it without inquiry,” University of Tennessee law professor University of Tennessee law professor Joan MacLeod Heminway said in an email.

“The board’s consideration would include the nonprofit’s purpose and mission, including the financial and other operational impacts of the proposal in light of that purpose and mission,” she said.

If an organization is interested in buying Alive, the board “always has a fiduciary duty to look out for the interests (of Alive).” The board needs to evaluate what it means for Alive, and that’s a long process, Hampe said.

During the spring controversy, the Alive board “did their due diligence and concluded that Alive’s mission can’t continue if we do something like that (become part of a for-profit organization). That’s not what we want to do. We know what our relationship with the community is. … The board went through that, and at the end of the day I know they made the right decision. Every senior manager and employee is grateful for that,” he said.

Hampe came to Alive Hospice in 2012 as its chief financial officer. He was its chief operating officer when he was named interim CEO on June 15 and continues in that position. He has worked in healthcare public finance and in financial roles at two Arkansas hospitals.

“When I saw Alive was looking for a chief financial officer, I thought it was a good place for me to be,” he said. His mother received hospice services during her life-limiting illness, and one of his children had cancer as a youngster. He accepted the CFO position at Alive intending to continue working there for the rest of his career. 

Alive board chair Vicki Estrin’s experience is similar.

“What drives all of us as a board is that we have been personally touched by hospice in some way and most of us have been touched by Alive,” she said. “Alive’s mission is to care for those patients in the best possible way.

“…We love Alive. Nobody wants that mission to go away,” she said. Estrin, an industrial engineer and healthcare management consultant, has worked in healthcare for 30 years, mostly with providers. She said she values serving on Alive’s board because of its work as a community healthcare provider. “I believe in communities coming together to provide access to health care regardless of ability to pay.”

Since Alive announced it would remain a nonprofit, members of its board and Keep Alive Alive members have come together to talk about concerns and common goals. Keep Alive Alive includes Alive Hospice founders Lynn and David Barton, employees, past board chairs, volunteers and others. They have met once and another meeting is planned, Lynn Barton said.

Both groups love Alive Hospice and have seen how the hospice has taken care of their loved ones, she said.

“At the end of the day, we all want Alive’s mission to sustain for a very long time in our community,” Estrin said. “I understand healing needs to happen in the community; we need to have these conversations about Alive’s future to ensure it continues to deliver on its mission.”


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Kathy Carlson
Kathy Carlson

Kathy Carlson is a veteran newspaper reporter and copy editor, with stints at the Nashville Banner and Tennessean. At the Tennessean, she worked on the police and business beats. She later wrote about employment law for M. Lee Smith Publishers. 1 For the past several years, she has been a freelance journalist. As a contributor to the Nashville Ledger, she has written about COVID-19, public health, education, voting during the pandemic, and a variety of governmental, legal and policy issues. Several ofher Ledger articles have received first-prize recognition 2 in Tennessee Press Association annual competitions. She will be working as a volunteer poll watcher with Organize Tennessee on Thursday.