The chasm between the perceived need for hospice care and referral from nursing homes has grown due to lack of education and the knowledge that hospice is able to complement nursing home care. In conversations with social workers at various nursing homes, administrators are directing the preference that palliative care and hospice care be kept “in house” for financial reasons versus outsourced to hospice companies who are experts in providing care. While this seems like an apparent conflict of interest the reality is that financial concerns do come into play versus patient best interest. When no family is near or exists, nursing home staff does control the quality and level of care. Again another case for family members to become more involved in the care of family members and to question motives of expertise when care is involved.