Private Equity Ownership in Hospice Care: A Systematic Review (2012-2026).

Hospice care is associated with improved end-of-life outcomes. Recent shifts in hospice utilization highlight several key trends. Alzheimer's disease and related dementias (ADRD) (25%) have surpassed cancer (23%) as the leading primary diagnosis. Concurrently, industry ownership has transitioned from predominantly nonprofit to for-profit (70%) and private equity (PE) ownership has grown dramatically from 3% to 15%. To date, no study has synthesized evidence on PE ownership in hospice care. We conducted a systematic review of English-language, peer-reviewed studies published 2012-2026, following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Of 630 screened articles, 114 underwent full-text review and 6 met inclusion criteria. All studies used national data; sample sizes ranged from 80 to 536 PE-owned hospices. Three studies examined PE prevalence and market trends; two assessed caregiver-reported care experiences, and one evaluated financial outcomes by PE ownership. The evidence regarding PE ownership of hospices remains limited. It highlights the increasing role of PE in hospice markets. It consistently found (across two studies) worse care experiences at PE-owned hospices vs nonprofit hospices, except for emotional and religious support which was similar across ownership type. The evidence suggests PE ownership is associated with complex, often worse patterns related to market structure, care experiences, and financial allocation. Additionally, it underscores the limited evidence base to inform policy development. Research is needed to examine associations between PE ownership and hospice care quality, both overall and among vulnerable populations. Research should clarify modifiable factors influencing hospice quality and better characterize evolving ownership structures.