5 Hospice Trends to Watch in 2026

Hospice leaders will need to keep their eyes on five key trends in the new year when it comes to compliance, business operations, finance and perceptions of dying among the public.

Utilization of hospice is rising throughout the county, a trend likely to continue. While this is welcome news, this likely means hospices will have to do more work with fewer resources due to reimbursement pressures.

The hospice community is also likely to see a substantial uptick in M&A activity as interest rates fall and other financial factors realign. At the same time, adoption of new technologies will become more widespread.

In the midst of these trends, recognition of the importance and the burdens faced by family caregivers will also continue to grow, with some health care providers, including hospices, taking action to provide greater support.

Finally, representations of death and dying in pop culture can influence the way patients think about the end of life. Hospices can find ways to leverage these stories in patient and family education and community outreach.

Below are five major trends affecting the hospice space in 2026.

M&A (finally) rallies

An anticipated resurgence in M&A last year did occur, although not until the end of 2025. This year, expect this trend to take firmer hold, reversing a three-year decline in deal volume. Several factors contributed to the multi-year decline in deal activity leading up to Q4 2025.

The cooling period began in 2023 after a surge of transactions in 2021 and 2022. Driving the earlier boom were record-high valuations, with multiples reaching 26x in 2019 and climbing to 29x the following year. In subsequent years, many companies focused on integrating acquisitions and creating value from their newly acquired assets. In 2025, activity shifted toward smaller or regional transactions.

Regulatory uncertainty played a significant role in the downturn. Buyers have been wary of potential Medicare payment clawbacks, particularly in four states under enhanced oversight by the U.S. Centers for Medicare & Medicaid Services (CMS): Arizona, California, Nevada and Texas.

While the regulatory headwinds have not abated, some of the financial considerations have improved, including gradually falling interest rates. Many buyers, particularly private equity firms, take on debt to make purchases. Also, assets that PE firms purchased in the banner years of 2021 and 2022 are reaching maturity and ready to come to market.

Another major factor is the growing alignment between sellers’ and buyers’ expectations as far as sale prices are concerned. The longstanding valuation gap is closing, and many sellers are no longer seeking the premium amounts that they saw in prior record-breaking years. This trend is pushing buyers to become more aggressive.

Hospice M&A activity rebounded sharply in the fourth quarter, reaching the highest deal volume the industry has seen since 2021.

There were 16 hospice transactions in Q4 to date, according to the M&A advisory firm Mertz Taggart — up from six deals in the third quarter and five in the second. The fourth-quarter total marks the most hospice acquisitions recorded since late 2021.

Some of the most notable transactions in the fourth quarter included Linden Capital Partners’ acquisition of Agape Care Group in July and The Pennant Group’s (Nasdaq: PTNG) $146 million purchase of former Amedisys and UnitedHealth Group (NYSE: UNH) hospice and home health locations in Tennessee, Alabama and Georgia. Financial terms of the Agape deal were not disclosed.

Additional transactions included Uplift Hospice’s acquisition of Tucson, Arizona-based Grace Hospice & Palliative Care and Grace Medical Group for an undisclosed sum. CommonSpirit Health at Home also acquired the hospice operations of Good Samaritan Hospital in Vincennes, Indiana.

Elsewhere, Hospice of the Chesapeake purchased the senior services organization Partners in Care of Maryland, while LifeCare Home Health acquired Infinity Hospice Care. Financial terms of both deals were not disclosed.

One of the more unusual transactions in recent years involved the breakup of Traditions Health, which was sold to four buyers that divided the company along geographic lines. The Care Team, VitalCaring, LifeCare Home Health Family and Mission Healthcare each acquired portions of Traditions Health’s locations. Financial terms were undisclosed. Traditions Health was previously a portfolio company of private equity firm Dorilton Capital Partners.

In the nonprofit space, Hospice of Santa Cruz County and Hospice East Bay completed their affiliations with Chapters Health System. Georgia-based Inspire Hospice and Palliative Care also affiliated with Cadre Hospice.

Hospice bets bigger on the AI boom

Hospice providers will continue to make deep investments in technology, particularly AI solutions. At the same time, providers will be exercising more caution about this powerful tech, particularly as government scrutiny and public concern shape AI compliance and new guardrails.

Hospice providers, like the broader health care sector, are increasingly turning to technology to support clinical and business operations. Emerging tools — including artificial intelligence (AI), telehealth and robotic process automation (RPA) — are becoming central to how providers deliver care and manage resources.

For several years, AI has been used to predict when patients may become eligible for hospice or to identify the optimal time to start palliative care. These practices are gradually becoming more widespread, and providers are exploring additional ways to apply AI across operations.

One of AI’s most common applications in hospice care is the streamlining of documentation.

Hospices use documentation software to support a wide range of functions, including visit scheduling, updating care plans, recording interdisciplinary team notes, managing medications and providing bereavement services. AI systems also assist with billing, compliance tracking and communication with families, among other essential tasks.

Data support the growing importance of AI-enabled documentation in hospice care. Nearly 40% of respondents to Hospice News’ Market Intelligence survey rated documentation software with AI and machine learning capabilities as “very important.”

Voice recognition and dictation were the most commonly cited uses, reported by 53% of survey respondents, followed by real-time audit tools (22%) and predictive clinical alerts (19%).

These trends are driven in part by the need for hospices to improve efficiency amid staffing shortages and reimbursement pressures. While complete and accurate documentation is critical for regulatory compliance, patient safety and securing payment, the volume of required documentation can place a significant burden on staff.

Hospice nurses have identified documentation as their top job-related concern, according to a recent survey by The Amity Group. A major source of dissatisfaction is the way documentation encroaches on clinicians’ personal time: over 90% of respondents reported completing these tasks at home outside of work hours.

More broadly, technology is being leveraged to improve compliance, standardize processes and anticipate patient needs.

A growing trend involves using AI for back-office functions such as scheduling and resource allocation. By analyzing patterns in patient needs and staff availability, providers can optimize visit schedules — aiming to deliver the right care at the right time while reducing staff burden. AI is also used to assess patient risk factors such as falls or wounds, and even screen candidates during hiring. As these systems evolve, the number of potential AI applications in hospice care is likely to expand.

At the same time, 2025 will bring increased regulatory scrutiny of AI in health care. The trend began accelerating in late 2024: a U.S. Senate subcommittee report in October alleged that major insurers were using AI tools to improperly reject prior authorization claims, particularly in post-acute care. States such as Utah, Colorado and California have also enacted legislation regulating certain uses of AI in health care.

As hospice providers continue adopting AI in 2025, they will need to balance innovation with compliance, remaining mindful of evolving regulations and emerging best practices for responsible technology deployment.

Operating efficiency becomes make-or-break test

Reimbursement pressures and rising costs will require hospices to do more with less in today’s economic environment. Reimbursement increases over the last few years have fallen far behind the curve of covering the full scope of hospices’ financial needs.

Hospices received a 2.6% increase in Medicare base rate payments in 2026, per CMS’ final rule.

This exceeds the 2.4% increase the agency had initially proposed in April 2025. Overall, the 2026 adjustment translates to an additional $750 million in federal spending on hospice care. The aggregate hospice payment cap was also adjusted by 2.6%, reaching $35,361.44 in 2026, as outlined in the final rule.

Nevertheless, many stakeholders, including providers and national organizations, have said the 2.6% pay raise is insufficient.

Payment rate updates have not kept pace with inflation or rising care delivery and labor costs, an issue challenging sustainability and growth. The trend has brought many hospices to a tipping point, with some shuttering their programs temporarily or permanently due to financial strain.

Hospices are feeling the squeeze.

Hospice providers nationwide are experiencing margin compression, with nonprofit organizations shouldering the largest impact, according to the the Medicare Payment Advisory Commission (MedPAC).

MedPAC reported that the average Medicare fee-for-service margin for hospices dropped to 8% in 2023, down from 9.8% in 2022 and 14.2% in 2020. Among for-profit providers, the 2023 margin averaged 13.7%, while nonprofits collectively reported a loss of 1.3%. These figures do not account for cap overpayments or non-reimbursable costs.

These declines came amid record-breaking demand. In 2024, hospice utilization reached an all-time high of 53%, with more than 1.8 million Medicare beneficiaries receiving hospice care, totaling 148 million days of service.

These trends will require many hospices to tighten their belts and pursue innovation, including ancillary services as alternative revenue streams, to stay afloat, as well as examining their operations in pursuit of greater efficiency.

Perils, promise of informal caregiving drive changes

Without family members providing care in the home, services like hospice and home health would be virtually impossible to provide. Consequently, hospices and other health care providers are taking steps to strengthen support for family caregivers, particularly as access to respite care and other resources remains limited.

Roughly 63 million Americans provide ongoing, complex care to adults or children with a medical condition or disability, according to a 2025 report from the National Alliance for Caregiving (NAC) and AARP. Representing nearly one-quarter of the nation’s adult population, the current volume of family caregivers has risen 45% since 2015, the report found.

As the nation’s population ages, demand is becoming more widespread. The U.S. Census Bureau estimates that by 2030 roughly 25% of the country’s population will be older than 65, and the Administration for Community Living projects that two-thirds of U.S. adults will need daily assistance from a caregiver. Due to cost considerations, it is also likely that more care will be moved into the home setting, placing more responsibility on family members.

Caregivers often see their own health decline. This is exacerbated when the caregiver is an older adult or chronically ill themselves. Nearly 20% of unpaid caregivers fits one of these categories, according to the U.S. Centers for Disease Control & Prevention (CDC).

The expense alone can be a struggle for the 48 million unpaid family caregivers in the United States.

Roughly three-quarters of them spend upwards of $7,200 annually for costs related to caring for loved ones, AARP reported. For many caregivers, this amounts to 26% of their income, according to AARP. These costs can include patient medical and non-medical needs or lost income due to missed work days. Around 30% of caregivers cover rent or mortgage payments for their loved ones, while 17% pay for medical costs, AARP indicated.

The financial burden on caregivers is associated with a range of negative outcomes, according to a 2020 BMC Palliative Care study. These outcomes are particularly damaging for families who are “systematically disadvantaged financially,” leading to inequities in access and utilization of palliative and hospice care.

While the financial costs are measurable, the emotional and physical toll of caregiving is substantial but difficult to quantify. For most families, caregiving comes with an onslaught of constant stress, essentially living in “fight-or-flight mode.”

The nation’s health care system is lacking in support for caregivers of the terminally ill, who are facing these heavy financial and logistical burdens. Without assistance or relief, these difficulties can impede access to hospice and other types of home-based care.

Research has shown that patients who are faced with end-of-life decisions may be less likely to choose hospice unless they have a network of friends or family who can serve as home caregivers. Even when a caregiver is present, that person may be an older adult or ill themselves, or unable to be in the home around the clock due to work or other obligations.

However, some efforts have materialized to provide greater support, including among hospices and government agencies.

Massachusetts-based Croí Health is among these organizations. The company launched a new support group for adult caregivers of oncology patients. Held monthly, the community group offers resources and guidance to help caregivers navigate the emotional challenges of supporting a loved one with cancer.

Meanwhile, Maryland-based Hospice of the Chesapeake has introduced a standardized caregiver training program designed to enhance the work they had previously done in this area.

Arkansas-headquartered Hospice of the Ozarks has launched a non-medical care training program to improve caregiving support. The hospice’s Care Coaching program is being offered at no cost to family caregivers. Through the program, interdisciplinary staff use phone calls and in-person visits and assessments to assist caregivers who are navigating the needs of serious and terminally ill patients in the home.

Health systems are also stepping up.

RUSH University Medical Center’s Caring for Caregivers (C4C) program assists families and friends who care for adults aged 60 and older in their homes. C4C is part of a nationwide effort to support the more than 55 million Americans (about 21% of the U.S. population) who provide care for family members with chronic and serious conditions.

The program was designed to assist caregivers with managing depression, anxiety and other challenges of daily life and provide referrals to community and hospital resources. The C4C program begins with an assessment to measure current levels of anxiety, depression and caregiver burden and attempts to mitigate these difficulties.

In New York City, Mount Sinai Health System has opened a dedicated center to enhance support for patients’ family caregivers — the Steven S. Elbaum Family Center for Caregiving. The program is designed to address growing gaps in family caregiver support, which can have lasting impacts on both caregivers and the patients they serve, she said.

Launched in January 2025 as part of Mount Sinai’s clinical services, the center includes a dedicated caregivers clinic and in May began offering individualized psychosocial support to patients’ parents, partners, children, siblings and friends.

Mount Sinai is collaborating with the Center to Advance Palliative Care (CAPC) to develop a national caregiving program, including business plans and care models that can be adopted by health care systems nationwide.

Recognition of the perils of caregiving will continue to proliferate in health care, as will awareness of families’ importance to the health care system, particularly for services provided in the home.

Hospice, Hollywood achieve surprising synergy

Greater awareness of end-of-life care options may emerge from the realm of pop culture.

Popular media, including television shows, can shape how people think about and approach end-of-life decisions, according to new research from End Well, a nonprofit organization dedicated to ensuring that people experience the end of life in ways aligned with their values and goals. The study explored whether pop culture storylines centered on death and dying influence viewers’ behaviors around advance care planning.

The findings showed that viewers exposed to end-of-life storylines were significantly more likely to take action than those in a control group. These individuals were more inclined to start conversations about end-of-life issues, seek additional information about planning options, and share the locations of legal and financial documents. They were also more likely to discuss care preferences with loved ones, create or update advance directives, and assist aging parents with decluttering and future planning.

Previous research has found that advance care planning is associated with increased hospice utilization. Yet despite the fact that 90% of people in the United States say end-of-life conversations are important, only 27% have actually engaged in them, according to End Well.

A meaningful shift is occurring in how popular culture approaches death, dying and grief. For decades, death was treated as a failure — something hidden away in hospitals and institutions.

Today, audiences are seeking greater honesty. More television shows, films and podcasts are willing to explore the full complexity of these experiences — not only the sorrow, but also the love, humor and meaning that can exist alongside it. Projects such as The Pitt, A Million Little Things, Dying for Sex and The Gentle Art of Swedish Death Cleaning are helping audiences see death as an integral part of life, rather than something separate from it. These programs also depict supportive communities coming together around challenging decisions.

Health care providers can use these stories as natural entry points for conversations that patients often find hard to start. When a patient mentions watching one of these programs, providers can reference it in an organic way: “Did you happen to see that episode about advance directives? It got me thinking — have you had a chance to consider what would be important to you?”

Health care systems can also incorporate these narratives into patient education by offering simple viewing guides or discussion prompts linked to specific episodes. These tools can help patients reflect on what they’ve seen and connect it to their own values and priorities. When staff sense that a show or film has sparked curiosity or openness, they can gently build on that moment — by suggesting a palliative care consultation, sharing advance care planning resources or simply creating space for conversation. Even small, genuine interactions like these can have a lasting impact.

Ultimately, the goal is to meet people where they are. Television reaches audiences who may never read a pamphlet about advance care planning, but who can deeply relate to a character’s journey on screen.