Hospice Care in United States

United States

Hospice care is for terminally ill patients who expect to have six months or less to live. The most common primary diagnosis among Medicare-enrolled hospice decedents in 2020 was Alzheimer’s, Parkinson’s or other dementias, followed by circulatory/heart conditions and cancer. While standard medical care may focus on finding a cure, hospice care emphasizes pain control and emotional support for patients and their families. Hospice care can be provided in a patient’s home — where most individuals prefer to die — or in a freestanding hospice facility, hospital or long-term care facility. Services provided by hospice care include:

• Pain management and symptom relief.
• Medication, medical supplies and equipment.
• Emotional and spiritual support for the patient through counseling or other therapies.
• Bereavement counseling and practical support for caregivers.

Medicare Part A covers hospice for patients with a life expectancy of six months or less; however, less than half of all eligible beneficiaries use it. 

Expenditures for the Medicare hospice benefit have skyrocketed over the past two decades, from $2.2 billion in 1998 to $22.4 billion in 2020. Several studies have shown that hospice care use results in overall savings for the Medicare program. Depending on the length of stay and patient characteristics, the Medicare hospice benefit can save between $2,309 and $17,903 per hospice patient.

According to the National Hospice and Palliative Care Organization (NHPCO), the prevalence of hospice use among Medicare beneficiaries is higher among:

• Women compared with men. 
• Adults age 85 and older.
• White Medicare beneficiaries compared with those of other races and ethnicities. Studies show that Black patients are less likely to use hospice for reasons that include mistrust because of racism, fear that providers will deliver inadequate care and lack of knowledge about hospice and palliative care services.

Current Medicare policy requires patients to forgo all medical treatment for their underlying disease to receive hospice benefits, which may deter individuals from transitioning to hospice. Allowing the continuation of curative treatments that help ease symptoms, such as blood transfusions, could increase the use of hospice care. From 2016 to 2021, the Centers for Medicare & Medicaid Services ran a test of the alternative Medicare Care Choices Model (MCCM), which would allow Medicare beneficiaries to continue receiving care for their terminal condition while in hospice with the aim of improving care outcomes. Their evaluation found that MCCM enrollment resulted in reduced Medicare expenditures, increased use of the Medicare Hospice benefit and improved quality of end-of-life care. These results can inform strategies for new models that address the needs of those facing serious illness near the end of life. 

For information and resources on hospice care, visit the NHPCO website.

Abt Associates. “Evaluation of the Medicare Care Choices Model: Annual Report 3.” Rockville, MD: Centers for Medicare & Medicaid Services, October 2020. https://innovation.cms.gov/data-and-reports/2020/mccm-thirdannrpt.

Better Medicare Alliance. “Medicare Hospice Benefit and Key Considerations for Policy Changes in Medicare Advantage.” Issue Brief, February 2020. https://bettermedicarealliance.org/wp-content/uploads/2020/02/Hospice_IssueBrief.pdf.

Bogasky, Susan, Steven Sheingold, and Sally C. Stearns. “Medicare’s Hospice Benefit: Analysis of Utilization and Resource Use.” Medicare & Medicaid Research Review 4, no. 2 (2014): E1–14. http://dx.doi.org/10.5600/mmrr.004.02.b03.

DaVanzo, Joan E., Dorothy Chen, Jessica Greene, and Allen Dobson. “Hospice: Leading Interdisciplinary Care.” Vienna, VA: National Hospice and Palliative Care Organization, March 25, 2019. https://www.nhpco.org/wp-content/uploads/2019/05/Hospice_Policy_Brief.pdf.

Kranker, Keith, Boyd Gilman, Matthew Niedzwiecki, R. Vincent Pohl, Arnold Chen, Jonathan Gellar, Marlena Luhr, Patricia Rowan, Lauren Vollmer Forrow, and Danielle Whicher. “Evaluation of the Medicare Care Choices Model: Fifth and Final Annual Evaluation Report.” Mathematica, Inc., November 2023. https://www.cms.gov/priorities/innovation/data-and-reports/2023/mccm-fifth-annrpt.

“NHPCO Facts and Figures: 2022 Edition.” Alexandria, VA: National Hospice and Palliative Care Organization, December 2022. https://www.nhpco.org/wp-content/uploads/NHPCO-Facts-Figures-2022.pdf.

Nysæter, Toril Merete, Cecilia Olsson, Tuva Sandsdalen, Bodil Wilde-Larsson, Reidun Hov, and Maria Larsson. “Preferences for Home Care to Enable Home Death among Adult Patients with Cancer in Late Palliative Phase – a Grounded Theory Study.” BMC Palliative Care 21, no. 1 (December 2022): 49. https://doi.org/10.1186/s12904-022-00939-y.

Odejide, Oreofe O. “A Policy Prescription for Hospice Care.” JAMA 315, no. 3 (January 19, 2016): 257–58. https://doi.org/10.1001/jama.2015.18424.

Rhodes, Ramona L., Bryan Elwood, Simon C. Lee, Jasmin A. Tiro, Ethan A. Halm, and Celette S. Skinner. “The Desires of Their Hearts: The Multidisciplinary Perspectives of African Americans on End-of-Life Care in the African American Community.” American Journal of Hospice and Palliative Medicine 34, no. 6 (July 2017): 510–17. https://doi.org/10.1177/1049909116631776.