When a for-profit acquires a nonprofit organization: lessons learned from one home health/hospice's experience.

We live in a dynamic world, and like it or not, nothing is more constant than change. No one knows this better than home health managers and clinicians. The changes in home health practice over the past 20 years have been radical and tumultuous. Over these years, home health managers and clinicians have faced not only revolutionary changes in clinical practice, requiring new knowledge and skills to assure evidence-based care, but also an ever-changing healthcare finance and delivery system, characterized by managed care contracts, Prospective Payment System, Outcome and Assessment Information Set, healthcare reform, and an unstable economy. They have faced these challenges, adjusted, coped, and changed, as they continued to provide the best care they could to their patients. But even the most stalwart of home health managers and clinicians may be shaken when the agency they have worked with through all the changes of the past decade or two enters into a merger or acquisition arrangement with another larger age ncy. Before beginning work with an agency, most home health agency managers and clinicians seek an agency that shares their values and philosophy of care and has work/payment/benefit policies and processes that meet their personal needs. Upon accepting employment with that agency, they work diligently to help not only their patients succeed in achieving skilled home health and personal care patients in Virginia, Maryland, and the District of Columbia. With a newly revised mission to “provide high quality home health and hospice services to more patients,” the agency began seeking an opportunity to become a hospice-certified agency as well as to expand services to a larger geographic area. At the same time, a faithbased hospital, which was founded to serve the sick poor, was seeking to divest itself of its home care and hospice service division, where many managers and staff members had been long-time employees. Most of the managers and staff had served this hospital/faithbased home health/hospice agency and its patients for 10 to 20 years or more. After a period of thoughtful consideration and due diligence, PHR acquired the faith-based home health and hospice. This article seeks to address the fears, concerns, and negative and positive outcomes that the staff of a nonprofit home health/ hospice agency experienced when acquired by a larger forprofit agency. In addition, it discusses the ways in which the acquiring agency can best help the acquired agency’s staff cope with and prepare for change so ultimately the acquired nonprofit their healthcare goals but also the agency achieve its mission. So what happens when a relatively large, freestanding, forprofit home health agency acquires a hospital/faith-based nonprofit agency? In 1994, Professional Healthcare Resources (PHR), a proprietary home health agency, was founded in northern Virginia by a nurse entrepreneur with the goal of improving home healthcare for both patients and staff. By 2007, the agency had grown into a seven-office agency, serving