Hospice of Santa Cruz County merged with a Florida-based nonprofit last year. (Amaya Edwards — Santa Cruz Local/CatchLight Local)

SANTA CRUZ COUNTY >> Elaine Nast knows first hand the difference that quality hospice care can make. At 65, she’s had the responsibility of looking after her mother, who fell ill and passed away last year. When she needed help with her mother’s care, she found it in Hospice of Santa Cruz County.

“Just having the same eyes on her regularly, catching little things early. I mean the caregivers were excellent,” she said. 

Nast said that weekly nurse visits helped ensure that her mother, who was bedridden for six months, never had a bedsore. “That’s huge. That’s almost unheard of.”

That help made a critical difference for Nast, especially as she herself was undergoing chemotherapy and couldn’t always be there for her mom. 

For almost five decades, the local nonprofit has provided end of life support services including palliative care programs, music therapy and grief support groups. But since a merger with a larger nonprofit last year, the local hospice center has seen the beginnings of layoffs and service cuts that some staff worry could negatively affect the roughly 180 patients they serve on any given day. Recent tax documents show Hospice has served around 1,000 patients per year.

HSCC leaders told staff that effective Oct. 19 a larger round of layoffs would occur, including at least 11 workers, among them eight nurses and three social workers, as well as a reduction in weekend nurse staffing. In addition, the workers said that nearly half of the hospice’s palliative care patients have been discharged. 

In response to an interview request by Santa Cruz Local, hospice CEO Cathy Conway wrote in an Oct. 15 email, “our highest priority remains the continued delivery of high-quality, uninterrupted care to the patients and families we serve.” 

Conway did not respond to questions about the cuts.

These changes come about a year after the hospice merged with Florida-based nonprofit Chapters Health Systems. A former member of HSCC’s management team, who left this year and requested anonymity for fear of retaliation, said that the cuts are a concerning trend for the local hospice that has historically prioritized staff and patient wellbeing. 

“Unfortunately, that all started to crumble in front of my eyes over these last couple of years,” they said.

An anonymous source expressed concern for patients’ quality of care as a merger with a national organization leads to layoffs. (Amaya Edwards — Santa Cruz Local/CatchLight Local)

A reputation of exceptional care

Hospice of Santa Cruz County was founded in 1978 and serves Santa Cruz County, North Monterey County and Salinas. The nonprofit’s high quality of care, reflected in its four star rating on Medicare.gov, has made it a cherished mainstay in the community.

Leadership at HSCC cited financial struggles as a primary reason for the new affiliation with Chapters Health, which was finalized in September 2025. According to the hospice’s tax records, its net assets in 2025 were similar to what they were in 2015. 

The partnership is expected to reduce costs for HSCC by tapping services provided by Chapters Health, like human resources and pharmacy resources. At the time of the affiliation last year, the former staffer who spoke to Santa Cruz Local recalls being told by Chapters CEO Andrew Molosky that no programs would be cut and operations would continue as usual without interruption.

“That is what we were told,” they said. “But that’s not what we’re seeing.” Among the most concerning changes, they said, is the discharge of roughly half of the hospice’s palliative care patients — patients that aren’t prepared to forgo treatments for severe conditions but who still need help managing pain.

The former staffer stressed that palliative care is critical for helping a patient know when to transition to hospice and avoid pain at the end of life. “The benefit of having a palliative care program is that you’re going to have actually skilled members who will be able to detect and see when that time’s coming,” they said. “Half the issue is that a lot of people get on hospice way too late.”

Chapters did not address a list of questions and instead directed Santa Cruz Local to Conway’s statement. 

An uncertain future 

Some Hospice leadership, including its Senior Director of Operations and its Interim Director of Nursing, have also departed, according to an email sent to Hospice staff by Conway and reviewed by Santa Cruz Local. Conway did not respond to a question about those departures.

The changes mirror reported layoffs at other Chapters Health affiliated hospices in the West like Hospice of East Bay, where healthcare workers went on strike earlier this month to protest cuts. 

Chapters Health has made a recent push to expand its footprint in western states. It’s taken on Hospice East Bay, Hospice of Santa Cruz County, Nathan Adelson Hospice in Nevada and Willamette Vital Health in Oregon. That brings its affiliations to 15 across six states.

“We are strategically aligning our staffing model to strengthen and expand patient services, not reduce them,” Conway wrote.

The former member of HSCC’s leadership team told Santa Cruz Local that when they first arrived at HSCC, they got to see the hospice’s quality service in action.

“Hospices can function bare minimally, and that’s what I was used to,” the former staff said. “Then I came here and was like ‘woah, we really go above and beyond, we really go the extra mile of caring for our patients.” HSCC’s current four-star rating is not easily attained and is a standout in a field historically plagued by fraud, short staffing and corporate profiteering. 

Hospices primarily function using medicare funding — they receive per diem payments based on the amount of hospice patients they serve. But the former staff said this configuration has led to bad actors gaming the system by hiring minimal staff to reduce overhead costs. “A lot of non nonprofit hospices struggle specifically because they function more ethically,” they said.

Hospice of Santa Cruz County began operating in 1978 and has four-star ratings. (Amaya Edwards — Santa Cruz Local/CatchLight Local)

In June of this year, California enacted emergency regulations in hopes of curbing unethical hospice practices and fraud. Among the regulations are staffing requirements, including 24/7 licensed nurse coverage, a max caseload limit of 12 patients per nurse, and a maximum two hour nurse response time.

A history of cuts

Registered Nurse Mora Collins has worked for Chapters Health affiliated hospices on both the East and West Coast and said she’s seen a pattern of staff reductions. She first worked at Capital Caring 2020, which announced its affiliation with Chapters Health in 2022, before moving back to California in 2025 to work at Hospice of East Bay.

“A lot of the sort of cost-cutting measures that Chapters implements are just reducing quality care,” Collins said. At Capital Caring, she said the new leadership tended to run a lean “skeleton crew”, increasing nurse caseloads while reducing support staff. 

“My coworkers and I would fill out safety reports, as was the protocol for near misses, like patients almost fell or they didn’t get their medications as timely because we’re so short staffed,” she said. “We were told to stop filling out those safety reports rather than addressing those issues.”

When Collins moved to Hospice of East Bay, she said she saw a similar shift of increasing nurse caseloads. In addition to layoffs, Collins said Chapters Health scrapped the quality and education department that she was a part of. She’s since left Hospice of East Bay “in large part due to the Chapters affiliation.”

The former HSCC staff emphasized that hospice care is a team effort, and they worry staff reductions will mean remaining staff will be stretched thin.

“Hospice patients are unpredictable. They can change at any point, and you’re not just caring for patients. You’re caring for the families too,” they said. “Essentially, the case managers are going to hold the brunt of most of the work on their backs, which will lead to very poor care. You just can’t do it all as one.”

For her part, Nast emphasized the importance of quality hospice care — both for patients themselves and for their families, who often need support navigating grief — and worries that cuts to services could impact that care. “It’s the reassurance that the family gets from talking to the nurses — I mean, that’s huge.”

But she’s holding out hope that the changes in Santa Cruz are temporary and that they won’t fully compromise the ability of HSCC nurses to care for patients. 

“The nurses are so dedicated to this work,” she said, “and they will do everything they can to make sure people’s care is not compromised. But there’s only going to be so much they can do.”

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