The founders of Alive Hospice, the pioneering Nashville nonprofit that has sought to ease the suffering of the dying for almost a half-century, say the current CEO has cut off communication with them after they asked about rumors of a potential sale.
David and Lynn Barton told the Nashville Banner that they received a call from a social worker at Jewish Family Services, which has long-standing relationship with Alive, that other for-profit hospices had approached JFS after hearing that Alive was for sale. Lynn said Alive CEO Kimberly Goessele responded to her, “I guess the rumors have gotten out there.”
Barton asked Goessele if she and David could be allowed to speak to the board. Goesselle said she would have to check with the board, Lynn says, but the next contact was from board chair Vicki Estrin, who said she would relay the Barton’s concerns to the board. The Bartons insisted on speaking with the full board.
“We’ve been stonewalled,” said David Barton.
Through a spokesperson, Goesselle issued the following statement to the Banner:
“Alive’s Board of Directors and leadership are often approached by organizations seeking different kinds of partnerships and affiliations,” read the statement. “The Board evaluates these opportunities and only pursues those that support Alive’s mission and advance our 45-year legacy of providing loving care to the people, families and community we serve. We explore many more potential partnerships than we ultimately pursue and cannot speak to rumors or conjecture.”
When asked why the Bartons were not allowed to speak to the board, given their history with the organization, Goesselle again responded through a spokesperson.
“The Alive Board of Directors is the governing board that is responsible for making informed judgments on behalf of Alive to ensure it can carry out its mission, both today and in the future,” Goesselle says in an email. “The Bartons are not members of the Board of Directors but are members of the Advisory Committee that provides support to Alive in certain areas but is not the governing board.”
Mary Falls, a former Alive board chair, made a similar inquiry this week.
“I am deeply concerned that the future of this community gem is now in jeopardy,” Falls wrote in an April 25 email. “Of course, the non-profit hospice model has always been difficult to sustain, so I am particularly skeptical that a for-profit will better serve those in need. What on earth has happened to Alive in the last couple of years that requires the sale of one of the oldest and best not-for-profit hospices in the country? As a former M&A lawyer, however, I am happy to be convinced that my skepticism is misplaced. Could you please do the Advisory Board the courtesy of an update on this vital matter?”
Falls said Goesselle responded to her the next day and said she was not allowed to confirm or deny anything.
Alive was one of the first hospices in the country when it was founded by David Barton and John Flexner, a pair of Vanderbilt doctors, in the 1970s. For their life’s work, the pair was inducted into the Tennessee Healthcare Hall of Fame in 2021.
“I was insistent on it being a nonprofit,” said Barton. “What gave rise to this was work at Vanderbilt I was doing on dying and death. I did one of the first classes on this at a medical school in 1971.”
The idea of caring for the dying and their families grew out of a movement in the U.K. in the 1960s and was heavily influenced by Elisabeth Kubler-Ross’ 1969 book On Death and Dying, which was built on interviews with more than 500 dying patients. By 1974, the first U.S. hospice was established in Connecticut. Alive was founded in 1975.
“Even the name of the organization has meaning,” said Barton. “The idea was that you treat dying people well because dying is a part of life. Dying people deserve care that is individualized because these are unique circumstances. The organization is built around that. And families have needs — the idea was caring for the people that work with dying people.”
Alive eventually grew into a multimillion-dollar operation, with campuses in Nashville and Murfreesboro and services throughout Middle Tennessee. In 2020, according to federal tax returns, Alive Hospice generated more than $37 million in revenue and had net income of $1,975,188. The land for the Nashville facility in Midtown was purchased in 1993 for just $180,000, but is in one of the hottest areas for construction in the city currently, between Charlotte and Church streets.
“The financials seem to be fine, we don’t understand why they’re doing this,” Lynn Barton said.
David Barton said he is particularly concerned about any sort of move toward for-profit hospice care.
Hospices were largely nonprofits until Medicare made the hospice benefit permanent in 1985 and the number of for-profits steadily increased, from 30 percent in 2000 to 73 percent in 2020. But according to a major study in the February issue of the Journal of the American Medical Association, for-profits provide “substantially worse care experiences” than nonprofit hospices.
Reads the report: “Analyzing surveys completed by family caregivers of patients treated by more than 3,100 hospices nationally, RAND researchers found that family members reported worse care experiences on average from for-profit hospices across all of the domains assessed, including help for pain and other symptoms and getting timely care.”
Barbara Shey, a registered nurse from Long Island, explained the difference between the models in her experience.
“I worked for a wonderful community-based hospice,” Shey said in comments to JAMA. “It was acquired by a large healthcare company, which was led by people who had no idea what happens at the bedside of a hospice patient. When they came out with ‘productivity guidelines,’ to spend no more than 20-25 minutes with a patient, see 5-6 patients a day (not considering drive time and finding parking between patients), and already knowing what the CEO’s take-home salary was, I retired.”
The pressures of a for-profit operation on delivering health care to people at the end of life were exactly why Alive was constructed as a nonprofit organization, David Barton says.
“I never thought in my mind that someone would be interested in selling Alive Hospice,” he said.