Washington hospice nurse Milli Palmer says her longtime nonprofit workplace changed rapidly after it entered a partnership with a private equity-backed company.
Workers say the deal was followed by pressure to move faster, keep up despite limited staffing, and, in some cases, falsify records.
What happened?
In May 2025, Compassus took over daily operations after Providence announced the previous October that it was creating a 50/50 partnership with the private equity-backed home health company, according to Stateline.
Palmer told Stateline that nurses and caseworkers who had been managing 13 to 15 patient visits a week were then expected to fit 20 to 25 visits into the same eight-hour shifts. She also alleged that some employees were instructed to falsify forms or backdate legal documents.
"It has really limited our ability to make sure that patients are safe in their home," Palmer said, per Stateline.
April Frazier, a hospice chaplain and Palmer's coworker, said she filed a complaint after management allegedly directed employees to classify missed visits as patient-requested rather than document that no staff member was available to make them.
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"A really big issue is taking on patients and making promises that they can be cared for, and it's not possible due to lack of staffing," Frazier said, per Stateline.
Why does it matter?
The partnership joins organizations with different priorities. Nonprofit health systems are supposed to meet community health needs and reinvest surplus revenue into care, while private equity firms usually focus on delivering investor returns on a shorter timeline.
Critics say that when those priorities conflict, patients and workers often bear the consequences first.
According to Stateline, which cited a study from the Private Equity Stakeholder Project, more than one-fifth of private equity-backed hospitals in the United States are held through partnerships with nonprofits.
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Matt Parr, communications director for the watchdog group, said regulations need to keep pace.
According to Stateline, Palmer said, "I think the public still sees us as Providence Hospice, not Providence at Home with Compassus," even though she believes "Compassus is gleaning patients strictly on the Providence name."
What's being done?
Palmer told Stateline that she and several coworkers filed complaints with both the Washington state attorney general's office and the state labor department. The attorney general's office declined to comment to Stateline on any possible investigation.
Regulators in California, Oregon, and Washington also reviewed the partnership.
Oregon's review lasted more than a year, and the state approved the deal only after requiring the venture to invest $30 million in home health and hospice services over five years and continue Providence's community benefit programs.
In their review, Oregon regulators explicitly described the concern: "To the extent providing better care to community members conflicts with profit objectives, for-profit owners would be expected to prioritize the latter."
"That's the heartbreaking part, when we know what good care looks like and to be pressured to do less than that," Frazier said.
Palmer put it more bluntly: "I know our communities are used to a certain standard of care, and if we don't provide that, we're not going to have a business here."
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