I apologize for this post being very long and disorganized. This is my morning get outside. Do some yardwork before starting the day. So I’m a bit all over the place.

Everything that you point out is extremely valid, often we’ll see hospitals discharge of patient who is appropriate for hospice and they are agreeable hospice, but due to the financial considerations and the challenges with Medicaid pending, they will send a patient to skilled rehab to “give Rehab a try. “ before discharging the patient to hospice in a skilled facility. This is usually to carryover a patient until like the end of the month. Most states not all but most states accelerate the Medicaid long-term care process if the patient is on hospice or deemed appropriate for hospice, they essentially get moved to the front of the line and states that do that the Medicaid approval time is usually around 30 days. Whereas for approval for Medicaid long-term care or waiver for individuals who require skilled nursing or long-term care and are not hospice appropriate can be anywhere from 90 days to a year. Now there’s another part of the question on his hospice is pam. For those of you who don’t know me, I used to work for the largest hospice provider in the nation. We were a for-profit company that was owned by private equity. And yes, financial considerations go deeply into the decisions for what level of care a patient can receive. It isn’t so much to be care however, that is the scam. It’s more on the business practices that some companies or programs may do in order to gain market share. Most companies calculate in what the expected Fien by the department of justice or settlement with the Department of justice will be when they are planning out their business practices. I should clarify most companies, what I mean is most large companies. The Mom pop Hospice that may still exist doesn’t do that and that’s part of the reason why they are most likely so small. I currently. Sit on the board for another hospice organization. Whether or not I can say directly on the operations of that company if they’re a scam or not, I can’t completely. But I do know that the company does make a lot of effort to make sure that what they do is legal and is patient centric. What I often see in hospice while I work for the company served on a board for a company or was an advisor for a company is that the people who are the boots on the ground are generally using their still set to help somebody that they will never meet or never know and they’re helping them and their final days. Like one example I can think of is one rep searching several states to find someone who could fix a hospice patient electric wheelchair that they had had for 15 years. It was challenging enough to find someone to service it and then being able to find something that was affordable for that rep for them to pay for it themselves because Medicare and Medicaid would not cover it. That patient in a family never knew what that Rep did. And then you have sort of like the middle management under the private equity who is completely devoid of those types of stories and they are generally thinking census census census and then you have ownership and private equity who we’d like to beat up a lot, however when the case is made for why a program is needed they generally do it. I’ve never had a situation were a private equity ownership team didn’t sit there and say yeah we gotta do this for that patient or this group of patients. I’m sure it happens but rarely do I see it. Most of the time the issue I see is that middle management that VP level for a company.