More than 100 NUHW-represented hospice workers in Sonoma County held a two-day strike in July, demanding a contract that would enshrine current patient care practices, including caseload limits, before Providence closes a deal to turn over operations of its two local hospices to a private equity-owned firm that has a track record of providing poor services.
Outside Memorial Hospice in Santa Rosa and Hospice of Petaluma, hospice workers — nurses, social workers, home health aides, chaplains, and more — held signs that read “Support Your Hospice Angels,” “Unfair Labor Practice Strike,” and “Support Hospice of Petaluma,” as passing cars honked and people waved.
The hospice workers have been negotiating their first contract with Providence since 2023, when they joined NUHW. Although workers at Providence hospitals in Sonoma County recently reached agreement on new contracts. Providence has refused to bargain in good faith with its hospice workers, leaving them increasingly concerned that the nonprofit healthcare giant wants to give Compassus a free hand to gut existing patient care protocols, increase caseloads, and leave caregivers with far less time for individual patients and their families.
“I’ve been a hospice nurse for almost 15 years and have been watching over the last 10 years as corporations have been taking over local hospice services in lots of different places, and it’s really hitting us now here in Sonoma County,” Camille Brody, a hospice nurse, told Northern California Public Media. “Providence is trying to strip away a lot of the practices that have made our hospice mean so much to the community.”
The strike was also covered by the Santa Rosa Press Democrat and Petaluma Argus Courier.
Providence, which owns Santa Rosa Memorial Hospital, Petaluma Valley Hospital, and Healdsburg Hospital, took ownership of Memorial Hospice and Hospice of Petaluma in 2016, becoming the largest provider of hospice services in Sonoma County. In 2024, the two Providence hospices accounted for 42 percent of hospice patients in Sonoma County and 55 percent of patient visits, according to California’s Home Health Agencies & Hospice Annual Utilization Report.
Starting in 2022, Providence became actively involved in running the hospices, firing managers, degrading its answering service, and forcing home health aides to see more patients every day, even though it meant less time for bathing patients and other critical duties. Still, because workers unionized in 2023, Providence was not able to change caseload requirements and other patient care standards that have allowed it to maintain high ratings from the families it serves.
However, Providence has announced that it’s forming a 50-50 joint venture with private equity-owned Compassus to jointly own Providence’s hospice, home health, and long-term care businesses, with Compassus as the operator. The agreement is expected to go into effect later this year. Since the announcement, Providence has gutted its grief counseling services, which also serve local schools, prioritized increasing enrollment at the expense of patient visits, and cut spending on supplies, even refusing to provide more expensive liquid medication, which can be easier for patients to ingest.
“It’s a profound honor to serve hospice families,” said Kristina Nauheimer, a nurse at Hospice of Petaluma. “Hospice work is a calling, and to watch it turned into a big money-making machine like every other facet of health care is painful. I’m deeply committed to protecting our patients, and that requires winning a contract that honors the work we do.”
Private equity has been expanding into hospice care, which is vulnerable to profiteering because hospice providers are reimbursed by how many patients they’re serving, not by how many visits caregivers make. That provides an incentive for hospice operators to sign up as many patients as they can and provide as little care as possible.
Between 2011 and 2019, there were 409 private equity transactions in hospice, with 58 percent of those transactions involving the purchase of a nonprofit agency. Research by MedPac shows that for-profit hospices spend less on patient care than nonprofit hospices and have higher profit margins.
“Hospice care is at a crossroads in Sonoma County, and we’re fighting to preserve the patient-focused care residents in our community have counted on for decades,” said Tim Johnson, a social worker at Memorial Hospice in Santa Rosa. “Providence is often seeking to save money at the expense of patient care, and we’re worried that our services will be greatly reduced under a new private equity operator, unless we can enshrine protections in our union contract.”
Compassus has a checkered history as a hospice owner. It paid federal authorities $3.92 million to settle a False Claims Act case connected to its operations in Alabama and lost its Centers for Medicare & Medicaid Services provider agreement in Missouri in 2018 for being out of compliance with core services.
As the Sonoma County hospices prepare to transition into for-profit status, Providence’s actions at the bargaining table continue to concern workers. In addition to refusing to enshrine caseload limits and other patient care protocols into the contract, Providence is proposing to have the ability to reduce compensation and benefits, even though Providence reported a $78 million profit from its hospice, home health, and long-term care service lines in 2024.
“Providence is bargaining in bad faith so that it can run out the clock on negotiations,” said Sabrina Hearst,” a nurse with Hospice of Petaluma. “With no contract in place with us, Providence and its new private equity partner, Compassus, would have a free hand to continue their focus on profit-making to the detriment of patient care. We formed a union so that we’d have the power to advocate for the families we serve, and we are determined to secure a contract that includes strong patient care standards.”
