Regulation, patient access and technology integration will be watchwords for hospices as time progresses, according to HopeHealth President and CEO Diana Franchitto.
Franchitto is retiring from HopeHealth effective May 2027.
She has led the organization for two decades. The nonprofit health system provides hospice, palliative, dementia and home care in Rhode Island and southeastern Massachusetts. Prior to joining HopeHealth, she was vice president of marketing and communications at Caritas Christi Health Care.
Founded in 1976, HopeHealth is the major teaching affiliate for hospice and palliative medicine of The Warren Alpert Medical School of Brown University. The organization operates a 30-bed general inpatient facility, the Hulitar Hospice Center.
What is the legacy you hope to leave as a hospice care leader?
It’ll be 20 years since I joined HopeHealth when I retire. What really struck me after having worked for other nonprofit healthcare organizations previously is how palpable the sense of mission is, and the sense of commitment to that mission.
We have built a foundation, became our region’s largest nonprofit providers of hospice and palliative care. We care for more than 1,500 patients and provide grief support to about 4,000 individuals a year.
When I think about strategy and legacy, one of the strategic initiatives and investments that HopeHealth has made is expanding access to care in primarily three areas.
One, we have a very strong general inpatient unit, and we expanded our borders from Rhode Island into Massachusetts about 10 years ago.
Two, we built strong healthcare partnerships with established leading academic organizations and healthcare systems. Those relationships have been decades in the making.
Underlying all of that is the culture. And that matters most to me, is the culture that supports all these strategic initiatives. We are certainly focused on compassion, clinical excellence and respect for our patients.
If I’ve helped build an organization that will continue delivering on that promise with strong and sustainable partnerships, that’s what I hope will be my legacy.
How have you seen hospice care delivery evolve?
I’ve seen it evolve significantly. So when I joined the organization, the [hospice] field was still relatively new, and it was a taboo subject. Hospice and palliative care were conversation stoppers. Now when I talk about the work that I do, it is a conversation starter, not a stopper.
From a societal perspective, to some extent we are still living in a death-denying, death-defying society. However, we’ve made huge strides. People want to talk about their hospice experience and their stories. I just find that so gratifying.
For every patient that experiences hospice, it doesn’t just grow by a factor of one. It grows by all the family members that have been involved in their care. So, it could grow by a factor of two to 10. That’s how the hospice movement grows, and I’ve seen it accelerate so significantly.
Do you think the COVID-19 pandemic changed the outlook of end-of-life care delivery when it comes to access and awareness?
After the pandemic, there was a lot of focus in society in general as people reevaluated what they do for their profession and work. There was this market shift where people wanted to do more purposeful work.
It’s a blessing to have the ability to have more purpose in life … by working in this field of hospice and palliative care. It is more rewarding than anything I could have ever imagined. When I talk with our new employees about the growth of hospice and palliative care, that is the impact it’s made for people.
What is important for today’s hospice leaders when it comes to sustaining and growing access?
I think it’s really important for leaders to appreciate that we have a responsibility to ensure that end-of-life care is accessible to everyone who needs it, regardless of financial circumstance. That’s where the complexity and the challenge comes. We want to provide it for people who deeply need it, yet we live in an imperfect reimbursement world.
It’s important for providers to strengthen their relationships with their local healthcare ecosystems and community organizations so that families understand how to access hospice and palliative care. It’s not easy to understand hospice and palliative care, and so it’s about how we engage with our communities more deeply.
What are the significant changes that hospices could see in coming years?
First, from a regulatory perspective, we will continue to see increased pressure and scrutiny, particularly as [the U.S. Centers for Medicare & Medicaid Services (CMS)] focuses on rooting out fraud, waste and abuse. No matter what party is in Congress, there will be significant scrutiny, hard stop.
Secondly, we are going to see access issues as it relates to the One Big Beautiful Bill. We don’t know exactly what will be the level of healthcare coverage loss, particularly as it comes to Medicaid. How are we as the hospice community going to look at that from a strategic perspective? We’re all in reading-the-tea-leaves mode right now and we’ll have to keep an eye on that.
Thirdly, with the baby boomer generation … there is going to be a significantly increased population of patients with dementia and Alzheimer’s. That is going to accelerate and families are going to be faced with enormours caregiving challenges. How the hospice community responds to those challenges will be critical.
And in the future, it’ll be a complete overhaul of technology. It’s really going to be amazing how technology is going to be able to enhance care for our patients and their families, but also enhance the work for our staff in ways what we may not even actually know about now. We probably can’t imagine what an [electronic medical records (EMRs)] are going to be in five or 10 years. It’s just growing and evolving quickly.
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