Hospice care is specialized support focused on comfort and enhancing the quality of life for individuals with a terminal illness. This approach centers on pain and symptom management, emotional support, and spiritual care rather than curative treatment. The philosophy of hospice is to allow a person to live their final months fully, often involving care in the location they consider home. Examining where this care is delivered provides a clear picture of how the service is accessed across the country.
The Current Landscape of Home-Based Hospice Care
The majority of hospice care is delivered within the setting a patient identifies as their residence, reflecting the common preference to remain in a familiar environment. Recent national data, based on Medicare claims, indicates that 51.8% of hospice care is provided in the patient’s private home. This percentage represents the single most frequent site of service delivery for hospice patients in the United States.
It is important to understand how “home” is defined in these statistics, as the term encompasses more than just a private house or apartment. The next most common location, the Assisted Living Facility (ALF), accounts for a significant 24.0% of hospice care. When combining care in a private residence and an assisted living facility, the proportion of hospice delivered in home-like settings rises substantially. These two locations establish the clear preference for receiving end-of-life care outside of a medical institution.
The primary model used in these home settings is Routine Home Care (RHC), which accounts for the majority of all hospice care days. RHC involves intermittent visits from an interdisciplinary team, including nurses, social workers, and aides, delivered wherever the patient lives. This model underscores the hospice benefit’s foundation as a service designed to bring comprehensive care to the patient.
Hospice Care Delivery in Institutional Settings
While home and home-like settings dominate, a substantial portion of hospice service is delivered in institutional facilities. These environments are used for specific needs, accounting for the remaining percentage of hospice care. The largest segment of institutional care is provided in Long-Term Care Facilities and Nursing Homes, which are the site of 14.7% of hospice services.
In these settings, the facility staff manages the patient’s routine daily care, while the hospice team provides the specialized palliative services. Skilled Nursing Facilities (SNFs) account for 5.0% of care and often serve patients requiring a higher level of skilled nursing attention for non-hospice related conditions. They are also sometimes used temporarily for General Inpatient Care (GIP) or Respite Care.
General Inpatient Care (GIP) is a short-term, acute level of service provided in a dedicated hospice unit or a hospital. This level of care is reserved for managing uncontrolled pain or severe symptoms that cannot be adequately managed elsewhere. GIP occurs in Inpatient Hospice Units (2.4%) and Inpatient Hospitals (1.4%), and its goal is stabilization so the patient can return to their home or residential setting.
Influences on Hospice Care Location and Future Trends
The distribution of hospice care locations is shaped by patient and family preferences, which favor a home-based death. The ability to remain in a familiar environment, surrounded by loved ones, is a strong driver for the high percentage of care delivered in private residences and assisted living facilities. This preference is supported by the Medicare Hospice Benefit structure, which covers the intermittent care provided through the routine home care level.
A major factor enabling home care is the availability and capacity of the primary caregiver, usually a family member. When a patient’s symptoms become too complex, or the caregiver experiences burnout, institutional settings like GIP units or facilities offering Respite Care become necessary supports. Reimbursement models also favor this distribution, as Routine Home Care is the most common and least costly level of care, aligning with the preference for non-institutional service delivery.
Looking ahead, demographic shifts, such as the aging of the population, are expected to further accelerate the demand for home-based care. Policy changes, including the shift toward value-based care, are creating incentives for providers to improve care coordination in the home setting. External events, like the recent pandemic, also highlighted the importance and feasibility of delivering high-quality, continuous care outside of traditional institutional environments.