Brookdale Senior Living’s (NYSE: BKD) hospice business drove growth in its health care services segment, despite fourth quarter financial results from the overall segment that were below expectations.

Brookdale Senior Living Inc. is a national senior living community operator whose health services segment provides hospice, home health care, and outpatient therapy services.The company owns and operates 844 facilities with a combined 80,000 residents, including independent living, assisted living, memory care, and continuing care retirement communities.

“[Health care services segment] revenue increased 1.1% for the quarter and 2.4% for the full year compared to prior year periods. While health care services didn’t meet our expectations, what stands out is the hospice business,” Steven E. Swain, Brookdale’s executive vice president and CFO said in an earnings conference call. “Although less than a quarter of the segments revenue, hospice growth was so significant and it drove this segment how overall revenue growth.”

Brookdale in 2019 committed to growing its hospice operations primarily through de novo activity and same-store admissions. Brookdale in 2019 opened hospices in Detroit, Portland, Ore., and Sacramento, Calif.

Patients do not have to be residents of Brookdale’s senior living facilities in order to receive hospice care.

Brookdale’s hospice operations brought in $26.1 million in revenue during the fourth quarter of 2019, up from $21.5 million in Q4 2018. The company’s home health business, by comparison, fell to $77 million in Q4 2018 from the prior year’s $81 million in Q4.

“As a result of Brookdale’s scale, we’re in the unique position to touch thousands of resident and family lives across the country. Brookdale Hospice takes that passion for care one step further by providing comfort and support at the end of life,” Anna-Gene O’Neal, division president of Brookdale Hospice, told Hospice News. “No one walks the end-of-life journey alone. We strive to provide grace in a time of stress and healing in a place that has no cure, for the entire family.”

Factors contributing to the poorer than expected overall health care segment’s performance included concerns related to customer service, salesforce turnover and disruption on the home health side as a result of the transition to the Patient-Driven Groupings Model (PDGM) that became effective at the start of 2020.

Effective Jan. 1, 2020 Medicare began reimbursing home health care providers through PDGM, which classifies patients into payment categories based on clinical characteristics and other patient information, and shifts the home health payment model to a 30-day payment period rather than the current 60-day episode.

“Our health care services business continues to face headwinds in the fourth quarter. Our new leadership team will make crucial decisions to improve our business, prepare for the new PDGM model and set the foundation to return to growth,” Brookdale CEO Lucinda Baier said in the earnings call.