Average Hospice Length of Stay on the Rise

The average length of stay for hospice patients in the United States rose 5% to 77.9 days during 2018, up from 74.5 days in 2017, according to a new report from health care data analytics firm Trella Health.

Length of stay has been a double-edged sword for the hospice industry. A main goal for most hospices is to bring patients under their wings earlier in the course of their illnesses. For many patients length of stay is a week or less, which is too short for them to receive the full benefit of hospice care.

The No. 1 complaint that families report on hospice Consumer Assessment of Healthcare Providers and Systems (CAHPS) surveys is that they wish their loved one had entered hospice sooner, according to the U.S. Centers for Medicare & Medicaid Services (CMS)


However, longer lengths of stay can also draw the attention of regulators such as CMS and the U.S. Department of Health and Human Services Office of the Inspector General and lead to costly, time-consuming audits by those agencies.

“One contributing factor could be a higher incidence of patients with longer-term illnesses electing hospice care. Three categories made up more than 75% of admissions over the past four quarters: circulatory diseases, neoplasms, and nervous system diseases,” the report indicated. “While neoplasms are generally associated with shorter lengths of stay, diseases impacting the nervous system such as Alzheimer’s can cause slow deterioration in affected patients. In addition to diagnostic category, another factor leading to higher [average length of stay] may be providers referring patients to hospice earlier in their course of illness.”

Utilization also rose modestly during 2018, the report found. Between the first and fourth quarters of 2018, hospice utilization rose 0.1%, but saw a 6.6% increase between Q4 2018 and Q1 2019. This is consistent with longstanding trends of more patients entering hospice towards the end of the year or the beginning of the next.


At the state level, Delaware unseated Utah as the state with the highest level of hospice utilization during 2018. More than 60% of Medicare decedents received hospice care in that state during 2019. Utah fell to ninth in the nation at 51.2%, down from 59.4% in 2017. Arizona, Florida, Rhode Island, Iowa, Ohio, Arkansas and Wisconsin also surpassed Utah on utilization.

“While hospice utilization rates varied from a low of 18.1% in Alaska to a high of 60.8% in Delaware, 38 states were clustered between 40 and 52%,” the report indicated. “The median utilization rate was 46.9%, incidentally the same as the national average. From a market perspective, the top 10 hospice utilizers were more geographically diverse than those in the top 10 for post-acute referrals.”

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