Home Industries Health Services Room for one more? R.I. hospice agencies push back against Pathways’ proposal...

Room for one more? R.I. hospice agencies push back against Pathways’ proposal for another

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Katie Castellani

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07/25/2025

pathwayslogo — PATHWAYS HEALTHCARE LLC. is looking to establish a new hospice provider agency. But existing Ocean State hospice providers are pushing back.

CRANSTON – Pathways Healthcare LLC is looking to establish a new hospice provider agency in Rhode Island. However, existing Ocean State hospice providers are pushing back. Pathways, a for-profit Massachusetts-based health services provider currently operating as a nursing home care provider in Rhode Island, is looking to expand its presence in the Ocean State to

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CRANSTON – Pathways Healthcare LLC is looking to establish a new hospice provider agency in Rhode Island. However, existing Ocean State hospice providers are pushing back. Pathways, a for-profit Massachusetts-based health services provider currently operating as a nursing home care provider in Rhode Island, is looking to expand its presence in the Ocean State to include hospice care. The company plans to offer several services including: palliative care, pain and symptom management; emotional and spiritual support; family and caregiver education and specialized programs like bereavement support and culturally sensitive care. The company aims to address the “growing need for end-of-life services in Rhode Island” with existing providers are “at or near” capacity, according to Pathways’ proposal in the form of a Certificate of Need Application. Elsewhere in the proposal, a table shows that seven hospice providers in Rhode Island do not have documented availability or accessibility problems. Despite push back from several hospice care agencies in Rhode Island, the Health Services Council voted July 22 to recommend that the R.I. Department of Health approve Pathways’ proposal. Representatives for Gentiva Hospice, Harmony Hospice, Home Health and Hospice Care of Nursing Placement, Eden Hospice and VNA of Care New England all sent a joint letter to the Health Services Council objecting to Pathways’ proposal. Visiting Nurse Home & Hospice also submitted a letter to the council against Pathways' proposal. Their argument? Pathways didn’t prove there is a need for another hospice provider in Rhode Island as the existing agencies have capacity. Gentiva has 30 patients, with the ability for 200 to 250 more patients a year; Harmony has 92 patients, with capacity for at least 200 more; Home Health has 35 patients with capacity for 70 more; and Eden has 10 patients with the capacity for 40 and ability to raise that to more than 100 patients, according to the letter sent in March. Since the addition of new hospice agencies in recent years, most have seen their patient census drop, said Michael Bigney, an administrator for Home Health in a June 10 letter to the council. “We all have the capacity to take on additional patients without straining the system,” Bigney said in the letter. “Based on this information I am opposed to any additional hospice licenses being issued.” There are 12 hospice care providers in the state and it appears none are at capacity, said Diana Franchitto, CEO and president of HopeHealth in a separate letter to the council sent June 9. When asked for his response to these objections, Sean Talbot, chief operating officer for Pathways, pointed to statistics showing the state’s population is continuing to age. “We need to be ready for what’s coming,” Talbot said. “We’re truly excited to take care of patients in Rhode Island.” About 25% of the state’s population is 60 years old or older according to the 2025 Rhode Island Healthy Aging Data Report. This is up from 23% reported in the 2020 R.I. Healthy Aging report and the 20% reported in the 2016 report. The 2025 report notes that the age structure of Rhode Island’s older population has shifted younger. In 2025, 58% of the aging population was between 65 and 74 years old, 29% were between 75 and 84 years old and 13% were 85 years or older. In 2018, 56% of the aging population were between 65 and 74 years old and 15.5% were 85 years or older. Pathways’ proposal also notes a focus on serving rural, low-income and non-English speaking populations. While this would be beneficial, Pathways isn't the only service with multilingual staff and it's not an adequate argument for showing the need for another hospice provider, said Jennifer Fairbank, CEO of Visiting Nurse in a July 8 letter to the council. Kathleen Gerard, director for Advocates for Better Care in Rhode Island, noted the group hasn’t had the chance to pay as close attention to hospice care as she’d like. But, she doesn’t think a new agency should be turned away just because there’s enough. Instead, it’s more important to assess whether the provider has any record that raises concerns about the quality of care it provides. Franchitto made this point in her letter to the council. According to Medicare Hospice Claims data, 47.8% of Pathways patients were visited by a registered nurse or medical social worker in the final few days of their life, compared with the Massachusetts average of 64.3%. Pathways reported 54% live discharges [when a patient leaves hospice care before death], compared to the Massachusetts average of 50%. Also, 63.8% of Pathways’ patients were assessed for all seven of the Hospice Item Set Comprehensive Assessment required quality measures at the beginning of their treatment. The Massachusetts average for this was 94.4% From 2021 to early 2024, Pathways had two “Centers for Medicare & Medicaid Substantiated Complaints.” In response to these concerns, Talbot provided data showing improved metrics. Of its Massachusetts patients, 83.3% received visits in their last three days of life and 99.1% received visits near death. The national benchmark for these measures are 66.9% and 92.5% respectively. Talbot acknowledged Pathways falls behind the state in terms of the Hospice Item Set required quality measures, noting the process is complicated. But to improve these, Pathways is “actively engaged” in ways to boost performance across all the required assessment components. He also said that the measure of 54% of live discharges fails to account for the difference between early and late live discharges. Pathways has made “significant operational improvements” to address aide-related concerns, Talbot said. This includes hiring multiple in-house aides and reducing its reliance on third-party staffing agencies along with created an Aide Coordinator position charged with overseeing quality of aide services. The council’s report on Pathways’ proposal will be drafted by the Office of Health Systems Development staff, and brought back for review and adoption by the council – likely by the end of August, said RIDOH spokesperson Joseph Wendelken. Once the report is approved by the council, RIDOH’s director has five days to issue a decision. Katie Castellani is a PBN staff writer. You may contact her at Castellani@PBN.com.