Today, about half of older Americans receive hospice care before dying, and many consider it a godsend. But since hospices were launched in the '70s by pioneering community groups, for-profit companies have surged into the $17 billion field, and quality has slipped. For-profit hospices spend less on nursing and are less likely to offer critical care to patients. Government inspections, scheduled every six years, failed to ensure care for some of the nation's frailest people. Tens of thousands of patients, most of them elderly and frail, were dying without seeing a nurse in their last days.