Each year in the United States, hospice care serves an estimated 1.72 million Medicare beneficiaries. 1 Those who receive hospice services have access to many benefits: improved comfort and quality of life, a reduction in unnecessary hospitalizations and access to emotional and spiritual care for both patients and their families. There is a common misconception that hospice care is only for the final days of life, but in reality, patients qualify for an initial six‑month hospice period, with the option to renew as long as they continue to meet eligibility criteria and need ongoing support.
Unfortunately, the sobering reality is that 50% of hospice recipients are enrolled for 18 days or less. 2 With so many eligible patients missing out on the full benefit of hospice, what are the impacts of increasing hospice length of stay, and how can we improve access to this valuable service?
Current State of Hospice Length of Stay
As patients with chronic and complex illness near the end of life, care providers are in a unique position to advocate for early hospice intervention, yet as many as 20% of those who receive hospice care do so for only 1-4 days. 3 These short stays and late referrals negatively impact patient and caregiver experience, with more than 11% of bereaved family members in one survey reporting their loved one was referred to hospice too late. 4 Common barriers to timely referral include:
- Prognostic uncertainty
- Discomfort initiating end‑of‑life conversations
- Misconceptions about hospice eligibility
- Fear of “giving up” or patient/family resistance
Although these barriers are understandable, they are also modifiable. Offering education on hospice eligibility and benefits of care to providers, for example, can increase the likelihood of early referrals. 5 Organizations that partner with a reputable, experienced hospice agency also have the opportunity to request assistance in determining patient appropriateness from skilled intake teams who can evaluate eligibility.
Why Length of Stay Matters: Clinical and Human Outcomes
Along with improved patient and caregiver satisfaction, increased hospice length of stay has tangible clinical and human outcomes, avoiding “crisis admissions” to hospice care that add trauma to the already difficult end-of-life journey. These improved outcomes include:
Better Symptom Management
Earlier enrollment allows time to stabilize pain, dyspnea, agitation and other distressing symptoms, improving overall quality of life in the final days. Short stays often mean that patients die before treatment plans can take full effect.
Improved Patient Quality of Life and Alignment with Patient Goals
Hospice care is built on an interdisciplinary team model, with each discipline bringing a different lens, sharing plans, communication and accountability. Longer stays allow interdisciplinary teams to build rapport, understand patient goals and tailor care. This puts patient goals front and center and means that patients experience more days at home and fewer crises.
Reduced Hospitalizations and Burdensome Interventions
A large Kaiser Family Foundation survey illustrates that the majority of adults (70%) prefer to die at home. 6 At home, hospice teams can manage acute issues, preventing ED visits, ICU admissions and unwanted, aggressive treatments. Research has shown that this results in fewer hospital stays and fewer deaths in the hospital setting. 7
Stronger Support for Caregivers
Family caregivers—an estimated 2.3 million of them annually—spend an average of 20 hours per week providing care to a loved one at the end of life. 8 Longer hospice stays give these families:
- Education on caregiving
- Emotional and spiritual support
- Time to prepare for the dying process
- Access to bereavement services for up to 13 months after their loved one passes away
The Cost and Utilization Perspective
Hospice length of stay has benefits from the cost and utilization perspective as well. Hospice stays longer than 10 days are associated with lower Medicare end-of-life expenditures, with average spending up to 11% lower for those who utilize hospice for six months or more in the last year of life.9
With fewer high-cost hospitalizations and more predictable care trajectories, hospice care contributes to more efficient, goal‑aligned use of healthcare resources by preventing avoidable crises, reducing unnecessary interventions and ensuring that care delivered in the final months of life is both clinically appropriate and centered on patient comfort.
Practical Steps Clinicians Can Take to Support Earlier Hospice Referral
Along with identifying a high-quality hospice provider for consults, education and care planning, there are practical key steps that can help support patients gain earlier access to the benefits of hospice:
- Identify triggers for hospice conversations (e.g., functional decline, frequent hospitalizations, uncontrolled symptoms).
- Use the “surprise question” as a clinical prompt: Would I be surprised if this patient died within the next year?
- Normalize early conversations as part of good medicine, not a last resort.
- Document and revisit goals of care regularly.
Extending hospice length of stay is not about prolonging dying—it’s about improving the quality of living in the final months. When clinicians view hospice as a proactive, supportive intervention rather than a last resort, patients and families gain access to the full spectrum of comfort-focused, interdisciplinary care. By partnering closely with hospice teams, clinicians can ensure that every patient receives the compassionate, patient‑centered care they deserve at the end of life.
If you need a reliable, experienced hospice agency that can support excellence in end-of-life care for your patients, be sure to bookmark our hospice referral form today. Our specialists are standing by for fast, seamless eligibility assessments and admissions.
Deb Gallaher, MBA, MSN, RN, NE-BC, CHPN, is a Senior Hospice Clinical Education Specialist for Amedisys. She has 10 years of experience in hospice and is passionate about sharing her insights on high-quality care.
