How Long Does Hospice Care Last?
Hospice care provides enhanced benefits at the end of life, but most families choose hospice when their loved one has just days or hours to live.
Studies and surveys confirm the tremendous physical, emotional, spiritual and financial benefits of hospice care. Yet, the median lifetime length of service (MLOS) for hospice is just 17 days. The average lifetime length of stay (LOS) for Medicare decedents enrolled in hospice in 2021 was 92.1 days.1
How Long Can Someone Be in Hospice?
By definition, hospice is intended to assist patients and families once a patient has a prognosis of 6 months or less if the illness runs its normal course. Experts agree and research documents that hospice care is most beneficial when patients elect to receive hospice care for months, rather than weeks or days. In fact, a study published in the Journal of Pain and Symptom Management shows that hospice patients live an average of 29 days longer than those who do not choose hospice2.
While hospice can positively impact a patient in crisis to help them achieve their goals, it can do so much more if it’s received for a longer period. The more time the hospice team has to support the patient and family, the better the quality of life for the patient and the better the memories for loved ones following the loss including a lower risk of complicated bereavement and legacy creation.
With time to get physical symptoms controlled, there also is time to evaluate, process, and manage psychological and emotional pain.
Patients often learn to embrace this important stage of life, making connections, repairing relationships, rediscovering simple pleasures and making peace. Hospice helps patients live each day.
What Happens if a Patient Lives Longer Than Six Months in Hospice?
Hospice neither prolongs life nor hastens death. Instead, it makes the quality of the patient’s life the best it can be in their final months, weeks and days. There are no studies that demonstrate that hospice hastens death, but studies do indicate that some patients live longer when receiving hospice services.
If a patient lives longer than six months in hospice, a physician in conjunction with input from the interdisciplinary team will need to document and attest through the recertification process that the prognosis remains six months or less.
What Happens if a Patient Improves in Hospice?
It is possible, though uncommon, that a patient’s condition improves while in hospice care. A clinical improvement would lead the interdisciplinary team and hospice physician to evaluate whether the patient's prognosis remains six months or less if the illness runs its normal course. If the hospice physician in collaboration with the team determines that the patient is no longer terminally ill, the patient must be discharged from their care for extended prognosis.
In 2021, 17.2% percent of all Medicare hospice discharges were live with 6.3% being for extended prognosis.1 Other reasons for live discharge may include the patient revoking the hospice benefit, moving or transferring to another area or hospice provider, or the inability of the hospice to dispense its duties to the patient based on hospice policy.
A patient that is discharged for extended prognosis may be reevaluated when their condition declines with the resumption of hospice care if the physician determines the patient's prognosis is again 6 months or less if the illness runs its normal course.
When is the Right Time for Hospice?
If a patient has an advanced illness, and their physician deems them hospice-eligible, sooner is better for hospice care. The patient can receive the full hospice services they are entitled to, including pain and symptom management, and psychosocial care from a team of experts. Hospice services also help support caregivers with the assistance of a hospice aide, social worker, bereavement specialist, chaplain, and volunteers in addition to clinical care.
Typically, a physician determines that a patient is hospice-eligible based on a terminal prognosis of six months or less, with a declining functional status. Guidelines may also include 10% or more weight loss in the last 4-6 months, two or more hospitalizations or ED visits, decreases in physical activity and/or cognitive ability, and/or other comorbid conditions. The Palliative Performance Scale (PPS) is a tool the physician can use to assess functional status.
What Does End-of-Life- Look Like in Hospice Care?
Hospice care focuses on the comfort and dignity of the patient. Once a patient is actively dying, typical symptoms include unresponsiveness and a significant drop in blood pressure. In the final two days or less before death, clinical signs include:
- Death rattle
- Apnea
- Changes in breathing patterns
- Decreased urine output
- Pulselessness of radial artery
- Inability to close eyelids
- Grunting of vocal cords
- Fever
For more clinical signs by stage, visit our End-of-Life timeline blog. To find out what to do when a hospice patient stops eating or drinking, click here.
Hospice Provides High-Quality End-of-Life Care
Hospice isn’t about giving up. When treatment options for a disease have been exhausted or no longer work, hospice provides a way to live in comfort and peace without curative care. Hospice services improve the quality of the patient’s life by managing pain and symptoms, allowing them to remain in the comfort of their home, surrounded by family.
Many family members tell us: “We wish we knew about hospice sooner.”
1NHPCO Facts and Figures: Hospice Care in America. Alexandria, VA: National Hospice and Palliative Care Organization, Rev. ed. December 2023.
2Connor, Stephen R., et. al. Comparing hospice and nonhospice patient survival among patients who die within a three-year window. Journal of Pain and Symptom Management. 33(3):238-46.