Hospice Shifts from Home to Hospital

People’s homes became a less common setting for end-of-life hospice care last year, while the amount of hospice services provided in acute care hospitals and other facilities increased, according to a recently released report from the National Hospice and Palliative Care Organization.

Overall, about 59% of hospice patients in 2014 were in their place of residence at the time of death, the report shows. That’s a decrease from nearly 67% in 2013. In addition to private residences, NHPCO counts nursing homes and residential facilities as patients’ place of residence, if this is the setting the patient calls “home.”

The proportion of hospice patients receiving care in their private residence at the time of death decreased from about 42% in 2013 to 36% last year, according to the report. There was an uptick in the percentage of hospice patients being served in other settings at the end of life, as the chart below shows:

Source: National Hospice and Palliative Care Organization
Source: National Hospice and Palliative Care Organization

Yet, even as inpatient hospice care became more common at the end of life in 2014, the number of agencies that were part of a hospital system remained essentially unchanged from a year prior. In 2013, 19.8% of hospice agencies were part of a hospital system, while in 2014 that figure was 19.6%. Agencies operating a freestanding/independent hospice did increase during that time period, from 58.3% to 59.1%.

And the proportion of hospice agencies that were part of a home health agency also declined slightly between 2013 (16.7%) and 2014 (16.3%).

As for who was paying for hospice care, trends reflected broader patterns in the health care system; namely, the erosion of the standard Medicare benefit in favor of managed care. However, the most notable change between 2013 and 2014 was an increase in the Medicaid hospice benefit, which paid for 3.8% of patients in 2013 and 5% of patients in 2014.


The NHPCO Facts and Figures: Hospice Care in America report was released this month by the Alexandria, Virginia-based association. It draws on data from the NHPCO data set and member database, as well as from data made available by government organizations such as the Centers for Medicare & Medicaid Services (CMS).

Click here to access the complete document.

Written by Tim Mullaney

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