Everett hospice workers concerned for patient care after private equity takeover

Published 1:30 am Saturday, August 8, 2026

EVERETT — Home health and hospice workers in Everett are raising concerns that a recent management change is jeopardizing their ability to administer quality patient care.

In 2024, Providence Swedish announced a “joint venture” with Compassus, a home health company backed by private equity and based in Brentwood, Tennessee. Now, the organizations operate as “Providence at Home with Compassus,” providing home health and hospice services in the western United States.

In a joint venture, companies combine their resources for a single project while maintaining their statuses as separate organizations. While Providence and Compassus each have a 50% stake in the venture, Compassus has assumed management and day-to-day operations. In May 2025, the joint venture went into effect in locations across Washington, including in Everett.

After the announcement, some employees were wary of what a joint venture with a private equity company would mean for patient care. At the time, a Compassus spokesperson told The Herald it hoped to hire more clinicians and expand access to care.

But since the joint venture went into effect 15 months ago, more than 60 employees have left the Everett location, not including those who have retired, said Milli Palmer, a licensed practical nurse and a member of the union’s executive board. The location has historically been home to about 200 employees, Palmer said.

Union members say staff have left largely because of unsustainable patient load requirements and fear of losing their licenses. Throughout Washington, employees have filed dozens of complaints with federal and state agencies regarding what they say are inadequate patient care, wage theft and unsafe practices.

In a statement to The Daily Herald on Friday, Compassus said that “broad claims that suggest we do not maintain high standards of care, regulatory compliance, clinical integrity or support our caregivers are inaccurate.”

The joint venture is part of a growing trend in healthcare between private equity and nonprofits that is raising nationwide concerns over adverse effects on patient care, some experts say.

The joint venture affects 41 home health and hospice locations across the western and southern United States, including in Washington, Oregon, California, Alaska and Texas. In Washington, Providence at Home with Compassus now provides hospice and home health services to eight counties, with offices in Everett, Lacey, Tukwila, Spokane and Walla Walla.

In 2023, the Washington State Investment Board invested $450 million into the private equity fund that financed the joint venture. As the union representing two of the Providence and Compassus locations, SEIU 1199NW, negotiates its first contract with Compassus, members are asking the state to use its status as an investor to urge Compassus to secure protections for workers and address employee complaints.

‘A catch-22’

Before the joint venture went into effect, staff were expected to take on about 13 to 15 visits per week, said April Frazier, a chaplain with Providence at Home with Compassus in Everett. Now, Compassus is expecting staff to complete 20 to 25 visits per week. For Frazier, whose work area spreads from Edmonds to Index, that’s not always physically possible. While she used to have an hour for a patient visit, now she and other staff often have about 20 minutes, Frazier said.

In those 20 minutes, staff may have to check medications, give baths and educate the family about aspects of care such as proper positioning. They also support families as their loved one nears the end of their life, providing emotional support and helping with funeral arrangements.

“How can you do that in 20 minutes?” Frazier said. “And how disrespectful is that to not listen? To have the nurse be so pressured that they don’t have time to honor their moments? The same with bath days, telling them to take less time with the bath; that’s not possible or respectful.”

Palmer, a licensed practical nurse, now works from home but worked as a hospice nurse in the field at Providence for more than a decade. She agreed that 20 to 25 visits per week is unattainable.

“Everybody’s been working overtime because they are not going to provide less than quality care,” Palmer said. “You can’t just walk out on a patient’s family that are in tears because their loved one is dying. You have to be there and be present.”

At the same time, employees say Compassus has told them to avoid collecting too much overtime.

“It’s intimidating for our staff because if they don’t see the patient, they don’t meet productivity,” Palmer said. “If they do see the patient, they’re working overtime. So it’s a catch-22.”

As a result, Frazier said she’s had to scale back on the number of phone calls she makes each week to check in with families.

“I’m afraid,” she said. “If this is how bad it is now, how is it going to be next month, next year, let alone when me or my loved one is going to need this care?”

Employees have also reported delays in obtaining supplies for patients, such as for wound care. Some have even bought supplies with their own money in order to provide timely care to patients.

“We need to care for their patients in their homes,” said Anthony Harris-White, a home health nurse who works at Providence and Compassus’ location in Lacey, at a state investment board meeting in June. “If we don’t receive the supplies in the home in time for the visits, patients could end up being rehospitalized for wound infections.”

The Everett location has lost more than 60 employees since the joint venture went into effect. The Lacey location, which serves Thurston, Mason and Lewis counties, has lost more than 30, according to the union. Frazier and Palmer said Compassus has hired contractors to fill the gap, but it’s not enough.

Last year, Providence told The Herald it was pursuing the joint venture with Compassus because of the challenges of investing in home-based services given a national health care personnel shortage and rising pharmaceutical and supply costs.

In a statement to The Daily Herald on Thursday, Providence spokesperson Ed Boyle referred specific questions about patient care concerns to Compassus.

“Providence and Compassus share a commitment to providing safe, high-quality care for patients and families,” Boyle said. “Under terms of the agreement, Compassus operates the joint venture, which serves as the employer. We have confidence in Compassus as our partner and expect any concerns raised by caregivers to be reviewed and taken seriously.”

In its Friday statement, a Compassus spokesperson denied the employees’ claims.

“Compassus maintains policies, processes and oversight mechanisms designed to support high-quality patient care, accurate clinical documentation, and regulatory and legal compliance,” the spokesperson said. “We take very seriously any concerns about quality, workplace practices or regulatory obligations. Our colleagues can and routinely do share information confidentially through internal channels.”

‘Things weren’t getting better’

Providence at Home with Compassus employees knew operations would look different under new management, Palmer said.

“For a good five months, we tried to just work with the system and figure out what the quirks were,” she said. “But around October or November, we realized that things weren’t getting better.”

Around that time, staff began filing complaints with the state labor department over alleged wage theft. Compassus’ payment system automatically tracks mileage, and when employees input corrections — such as having to take a different route or running into a traffic jam — they haven’t been accepted, Palmer said. The company has also inaccurately tracked incentive pay for nurses, she added.

Since the joint venture, Providence at Home with Compassus employees across Washington have filed dozens of complaints over wage theft and violations of the state’s sick leave law, said Stacey Opiopio, the union’s senior member program director, at the state insurance board meeting.

On Friday, the Washington Department of Labor and Industries confirmed with The Herald that it has started investigating 47 workers’ rights complaints from 38 workers in the Snohomish County and Lacey locations. The complaints allege paid sick leave accrual and use issues, mileage expense reimbursement issues, and issues regarding meal and rest breaks, department spokesperson Matt Ross said.

Employees have also filed dozens of complaints with the state health department, federal health agencies and the state attorney general’s office regarding patient care and Medicaid and Medicare fraud, Opiopio said.

Frazier is one employee who filed a complaint with the state attorney general’s office. She said management asked her to inaccurately write in a patient’s chart that they declined a visit when in reality, there wasn’t a staff member available to visit the patient. She said it’s happened to several of her coworkers.

“They’re saying, ‘Be creative, make it sound like it’s patient-driven,’ even though it’s not, and that is wrong,” she said.

Private equity ownership

Compassus is jointly owned by St. Louis-based Ascension Health, which is a private Catholic healthcare system, and TowerBrook, a private equity firm based in London and New York City.

Since 2013, Washington state has invested more than $1 billion into TowerBrook’s funds, including $450 million into TowerBrook V, which funded the joint venture between Providence and Compassus, according to licensing documents with the Oregon Health Authority.

At a Washington State Investment Board meeting in June, members of SEIU 1199NW asked the board to use its status as an investor to put pressure on TowerBrook, saying the issues pose legal and reputational risks to the board.

“We didn’t say divest,” Palmer said. “We were not saying Compassus isn’t worth working with. We’re saying we need to take care of our patients.”

The investment board is currently in “ongoing discussions” with TowerBrook and Compassus regarding the concerns raised by the union, board spokesperson James Aber told The Herald in a statement Wednesday.

Union members also asked the state to urge Compassus to negotiate a fair contract. The Everett bargaining unit is currently negotiating its first contract with Compassus. After about nine months, Compassus has yet to bring a complete economic package to the table, Palmer said.

“Our patients deserve access to high-quality care supported by adequate staffing,” said Jane Hopkins, president of SEIU1199 Healthcare NW, in a statement Wednesday. “Our members deserve wages and benefits that allow them to support their families with dignity. They also deserve a strong, equitable contract that recognizes their essential contributions and ensures they are treated with the respect they have earned—not as second-class workers by Providence or Compassus.”

In its statement, Compassus said it will continue to bargain in good faith to attempt to reach a contract.

The Compassus and Providence arrangement is part of a growing trend of joint ventures between private equity and nonprofits in healthcare nationwide, said Matt Parr, communications director for the Private Equity Stakeholder Project, a nonprofit watchdog group that studies the effects of private equity. While private equity firms have been buying healthcare companies and hospitals for years, joint ventures are a relatively newer method, he said.

“This is another way for them to expand into different areas and use already trustworthy nonprofit names to their benefit,” Parr said.

In July, the Private Equity Stakeholder Project published a report on private equity joint ventures in nonprofit healthcare, using Compassus as a case study.

Parr said he’s heard similar staffing and supply concerns from workers at private equity joint ventures across the country.

“These are very typical things we see with private equity ownership, and now it’s filtering into these nonprofit system joint ventures, which we typically hadn’t seen in the past,” he said.

Since 2020, Compassus has pursued joint ventures with at least four large nonprofit companies for home health and hospice services. Compassus now provides home health and hospice services in more than 300 locations in 33 states, according to the report.

“You have very real problems happening at these Compassus facilities in multiple states, and yet the private equity-backed company is still very much trying to expand,” Parr said. “… The private equity companies are not focused on ending this type of expansion anytime soon.”

Proposed legislation

Some state and federal lawmakers are working to pass legislation to put guardrails around private equity in healthcare.

Earlier this year, the Washington state Legislature passed a bill aiming to increase transparency of significant healthcare transactions. The law, which went into effect in June, expands the definition of a transaction that requires review from the attorney general.

In Oregon, the state health authority is required to review significant transactions through its Health Care Market Oversight Program. The review significantly delayed the Providence and Compassus joint venture in Oregon, but the health authority ultimately approved the deal in May, despite hundreds of comments from healthcare workers in opposition.

“There’s a lot more information about how operations work in this company, just due to the fact that they’re aiming to expand into Oregon,” said Ryan Leitner, a researcher with the Private Equity Stakeholder Project. “In fact, the preliminary review in Oregon found that private equity ownership could significantly impact care delivery.”

State Sen. June Robinson, D-Everett, has worked to pass legislation that would restrict corporate involvement in medical care decisions. The bill would only allow licensed medical professionals to set policies regarding appointment length, patient discharge and treatment. Legislators have discussed the bill in the last two sessions, but it has yet to make it past Senate committees.

“It’s been very hard to get the votes to pass the bill,” Robinson said. “Healthcare entities push back, saying, ‘We have to have capital to survive in this world, and therefore we have to go out to private equity to get that capital.’ … It’s really challenging, and, unfortunately, it’s often patients who are on the losing end.”

Robinson also serves on the Washington State Investment Board. She said there have been conversations among board members regarding putting pressure on TowerBrook.

“The state investment board is large enough and has a good reputation, and conversations can lead to changes,” she said.

On the federal level, U.S. Rep. Pramila Jayapal, D-Seattle, introduced a bill in July regarding private equity in healthcare. The legislation would require private equity-owned healthcare entities to make financial information public, set up escrow accounts to cover expenses for five years in the event of a service reduction and prohibit private equity firms from undermining the quality of care, among other provisions.

Frazier and Palmer both said they decided to work in hospice because they enjoy providing care to patients in the comfort of their own homes.

“There’s all the sadness and difficulty, but also joy, and that’s what keeps me here too,” Frazier said.

For Palmer, she said she likes treating a whole person and family, rather than a disease process. For example, staff often help patients pursue their wishes near the end of their lives, such as going to their child’s wedding or visiting a loved one in another state.

“The majority of us that have stayed want (Compassus) to succeed because that means we succeed, and we succeeded for our community, and our patients are getting care, but we can’t do that alone,” Palmer said. “They have to give us the tools to do that with, and they have to give us the time to do that with, and the staff to do that with.”

Jenna Peterson: 425-339-3486; jenna.peterson@heraldnet.com; X: @jennarpetersonn.