The hospital district is seeking to stop the sale of Hospice of the Northwest to a for-profit corporation. In a letter dated Nov. 5, all five San Juan County Public Hospital District No. 1 commissioners cosigned a letter to Skagit Regional Health Care District No. 1 Commissioners pleading its case.

“We write to you as concerned citizens of San Juan County and as commissioners of San Juan County Public Hospital District #1. … Our community appreciates the high-quality services that Hospice of the Northwest provides, and we ask you to reject any offer to sell that operation,” the commissioners wrote.

Skagit Regional Health Care District No. 1 is one of two public hospital districts that own Hospice of the Northwest, the other is United General District 304.

“We recently learned that you are considering selling Hospice of the Northwest to Bristol Hospice, a for-profit corporation,” the commissioners wrote. “Our understanding is that for-profit hospice companies cannot devote as much funding to patient care as non-profit hospice companies.”

According to a story in the Skagit Valley Herald, the two public hospital districts received an unsolicited offer from Bristol more than a year ago and are “still exploring whether a sale could maintain or improve hospice operations.”

HNW has been serving Skagit, Island, San Juan and Snohomish Counties since 1989, providing access to nursing, medical, social and spiritual professionals, who “demonstrate compassion and dignity in the care they provide to patients facing serious illness and the loved ones who care for them,” according to the website. It has an administrative building in Mt. Vernon and all of its services are provided in patients’ homes or in a care facility. HNW also offers hospice services to the homeless.

Although San Juan and Lopez have volunteer organizations — Hospice of San Juan and Lopez Hospice and Home Support — only HNW can provide around-the-clock access to nursing support and other resources for end-of-life care. Patient care is funded by Medicare hospice benefits, Medicaid, private insurance or HNW’s charity care. The Hospice Northwest Foundation, a 501(c)3, fills the gap in insurance funding.

According to the commissioners’ letter, a study was done in July 2019 for the National Partnership of Healthcare and Hospice Innovation.

“The objective of this study was: Understanding the differences and similarities in financial performance and quality of care between nonprofit and for-profit hospices serving Medicare beneficiaries,” the commissioners wrote.

The study concluded that nonprofit hospices have an aggregate net margin of 3.0 percent versus 19.9 percent for for-profit hospices; nonprofit hospices provide patients with 10 percent more nursing visits, 35 percent more social worker visits, and two times as many therapy visit versus for-profit hospices per patient day; nonprofit hospices enroll a higher percentage of patients who have inpatient hospital stays immediately prior to hospice admissions, which suggests they may be high-acuity patients with greater care needs upon hospice enrollment; for-profit hospices report spending more than 300 percent more on advertising costs than nonprofit hospices; and for-profit hospices report spending less than half what nonprofit hospices report on bereavement services.

“With this information, it seems evident that the San Juan Islands will have fewer hospice visits and a reduction in overall services from Hospice of the Northwest if they were to be purchased by a for-profit company,” the commissioners said.

According to the letter, retired emergency department physician Roy Graves, who sits on the ethics board for Hospice of the Northwest stated, “It’s hard to imagine that you can take a functioning system, take money out for investors and still provide the same services.”

The commissioners noted that the islands have geographical challenges due to being ferry served. This challenge, they continued, is an added cost to hospice and home health care services for islanders.

“We know that Hospice of the Northwest is deeply committed to San Juan County and provides excellent care to those facing their end of life,” the commissioners said.

When Life Care Center of the San Juans closed its doors two years ago, it was after 50 years of service to the island, the commissioners explained. The closure resulted in islanders having to move to the mainland to continue receiving care, and their island families having to take mainland trips to see their loved ones.

“We have been gratified to learn that financial considerations do not play a role in your considering the hospice sale. We urge you to reject any offer to sell our well respected and beloved Hospice of the Northwest to Bristol.”

Colleen Smith contributed to this article.