What Hospice Care Looks Like in America

Hospice care is a growing sector of the health care system, and more older Americans are using the Medicare benefit than ever before. However, recent studies have shown that hospice care is used only at the very end of life, most often in the last two weeks of life, rather than for its full, six-month benefit.

With increasing financial interest in the sector and more participation, the hospice movement continues to play a vital and valuable role in health care, particularly as a service most often delivered at home. Here’s a snapshot of what hospice looked like in America, according to a recent report from the National Hospice and Palliative Care Organization (NHPCO).

The Basics of Hospice

Hospice is a Medicare benefit meant for beneficiaries in the final stages of their lives, covering services from pain management and medical care to emotional and spiritual support individualized to the patient and family. While hospice staff make regular visits with patients, they are often on call 24 hours a day, seven days a week, according to NHPCO.

“We need to continue reaching out to patients, family caregivers and other health care professionals to help them understand the benefits that hospice care brings, particularly when provided in a timely fashion as part of a continuum of care,” NHPCO President and CDO Edo Banach said in a statement.

Hospice can be delivered in a facility, including nursing homes, senior living and free-standing hospices, but is most often conducted in home settings.

In 2015, 1,381,182 Medicare beneficiaries were enrolled in hospice care for one day or more. Of all Medicare decedents that year, 46% of them were enrolled in hospice at the time of death. Medicare paid hospice providers $15.9 billion for care provided in 2015; the average cost per beneficiary was $11,510.

The majority of hospices are also for-profit organizations (62.8%), and 31.9% had not-for-profit status. Government-owned hospice providers comprised 5.2%, according to the report.

Key 2015 Stats

—4,199 hospices were paid by CMS to provide care

—72.2% of hospices were freestanding, independent organizations; 14.2% were hospitals based; 12.9% were part of a home health agency; 0.6% were based in a nursing home

—The mean average daily census was 63 patient; majority of hospices had an ADC of fewer than 50 patients

—Just 5.4% of hospice patients were younger than 65

—More than half of hospice Medicare beneficiaries were female (58.7%)

—86.8% of hospice patients were 86.8%

—The average days of care for dementia patients was 105 days; 23.9% of spending was for dementia patients

—Top three most contributory diagnoses to hospice: cancer (27.7%), cardiac and circulatory (19.3%), and dementia (16.5%)

—The average length of stay for hospice enrollees was 69.5 days; though 28.2% were enrolled for seven days or less

—1,007,753 Medicare beneficiaries died while enrolled in hospice care. 44.4% occurred at home; 32.3% at a nursing facility; and 15% at a hospice inpatient facility

—16.7% of discharges are live discharges from hospice

Written by Amy Baxter

Amy Baxter on EmailAmy Baxter on Twitter
Amy Baxter
Assistant Editor at Home Health Care News
When not writing about all things home health, Amy fulfills her lifelong dream of becoming a pirate by sailing in regattas and enjoying rum. Fun fact: she sailed 333 miles across Lake Michigan in the Chicago Yacht Club "Race to Mackinac."