Hospices Strategize for Longer Patient Stays

A majority of patients continue to experience short lengths of stay in hospice, in many cases limiting their ability to receive the full benefits of those services. Confronted with this reality, providers are seeking new ways to connect with patients further upstream in the course of their illness. 

Nearly 54% Medicare decedents received hospice care for 30 days or less in 2018, according to a new report from the National Hospice & Palliative Care Organization (NHPCO). About 28% percent of those beneficiaries were in hospice for seven days or less, which is considered too short a period for patients to fully benefit, NHPCO indicated.

This reality not only interferes with patients’ quality of life in their final days, it drives up health care costs as individuals who enter hospice later are more likely to receive expensive and aggressive curative treatments that often are unlikely to be effective at their stage of illness. 


“We continue to be concerned about the number of hospitalizations, emergency room and physician visits in the last year of life.  That raises the critical question about how one wants to spend their time when their time may be limited – at home with loved ones receiving support from hospice or in a never ending cycle of health care services?” said Lori Bishop, NHPCO vice president, palliative and advanced care.

About 80% of people in the United States say they would prefer to die in their homes as opposed to a hospital or other health care facility, according to the U.S. Centers for Disease Control & Prevention. 

The needle has barely moved on this issue from year to year. In 2017, 54% of Medicare decedents received hospice care for less than 30 days, only 0.2% higher than the 2018 numbers, NHPCO reported. 


Many providers are fighting this trend by offering a wider range of services to allow for earlier engagement with patients and families and create new revenue streams. Hospices nationwide have launched palliative care programs, home health services, PACE programs, home-based primary care and programs to address social determinants of health

Another strategy many providers are adopting is rebranding to remove the word “hospice” from their names. This can help organizations avoid the stigma that is often associated with hospice and make their services less frightening to patients and families who are confronted with difficult end-of-life decisions. 

The NHPCO report was not entirely bad news. More patients received hospice care during 2018 than ever before — 1.55 million patients, up 4% from the prior year. The national average for hospice utilization reached 50.7%, according to NHPCO.

In addition, more hospices are providing care in the United States. The number of operating hospices has risen 13.4% since 2014 to a total 4,639 organizations.

“This annual report provides a valuable snapshot of hospice care access and care, and also a reminder that we must continue to strive to make hospice care more equitable and accessible. It is also important to remember that behind these numbers are people who rely on person- and family-centered, interdisciplinary care to help them during a time of great need,” said Edo Banach, NHPCO president and CEO.

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