Characteristics of U.S. hospice programs
3300* estimated operational hospice programs in the U.S.
*Includes both primary and multiple locations for individual hospices
- 67% of hospices were non-profit
- 29% of hospices were for-profit entities
- 4% of hospices were run by the government
- 94.7% of hospices were Medicare certified
- 64% of all hospices were accredited
Characteristics of Patients Served by Hospice
Estimated number of patients served by hospice programs in 2003: 950,000
- 54% of hospice patients were female
- 46% of hospice patients were male
- 63% were 75 years of age or older
- 85.5% of hospice patients were White or Caucasian
- 8.9% of hospice patients were Black or African American
- 4.3% of hospice patients were Hispanic or Latino
- .9% of hospice patients were Asian or Hawaiian/Pacific Islander
- 4.2% of hospice patients were classified as multiracial or "Another Race"
Locations of all deaths
In 2003, for all Americans who died:
- About 25% died at home
- About 25% died in a nursing facility
- About 50% died at a hospital
- 15% in the emergency room and
- 35% in acute care
Locations of hospice deaths
- 50% died at home
- 22% died in a nursing facility
- 7.2% died in a hospice unit
- 9.0% died in a hospital
- 7.4% died in a free standing inpatient facility operated entirely by the hospice
- 3.6% died in a residential care setting
Diagnosis
Cancer diagnoses accounted for 49.1% of hospice admissions in 2003.
The top five non cancerous causes of death in hospice include:
- End Stage Heart Disease – 11%
- Dementia – 9.6%
- Lung Disease – 6.8%
- End Stage Kidney Disease – 2.8%
- End Stage Liver Disease – 1.6%
Length of Service
- In 2003, 36.9% of those served by hospice died in seven days or less
- 7.3% of those served by hospice died in 180 days or more
- The average length of service (ALOS) was 55.52 days
- The median length of service (MLOS) was 22.22 days*
*MLOS is a more accurate way to understand the experiences of typical hospice patients.
Level of Care
Based on percentage of patient days in hospice care
| Level of Care | 2003 |
| |
| Routine Home Care | 95.5% |
| General Inpatient Care | 3.4% |
| Respite Care | 0.2% |
| Continuous Care | 0.9% |
Amount of Care received by Hospice patients
In 2003, there was an average of:
- 39.2 staff visits per admission
- 1.4 days between visits
- 4.9 visits per week from hospice workers
- Volunteer Commitment: Approximately 400,000 hospice volunteers contributes 5% of all clinical hours provided to hospice patients and families. This is equal to over 18 million hours per year.
- Bereavement Support: On average, about two family members served per death and each receives two to three contacts: 21% of individuals served are community members who did not receive hospice care.
Cost of Care
- For every dollar Medicare spent on hospice, it saved $1.52 in Medicare Part A and Part B expenditures.
- In the last year of life, hospice patients incurred $2737 less in costs than those not enrolled under the Medicare Hospice Benefit.
- These savings totaled $3192 in the last month of life, as hospice home care days often substituted for expensive hospitalizations.
Source: 1995 Lewin VH1 study, commissioned by NHPCO
- Savings of $1.26 for every Medicare dollar spent on hospice.
- Twenty eight percent of all Medicare reimbursements goes towards the care of people in their last year of life; almost 50% of those costs are incurred in the last two months of life. Source: 1988 study conducted by HCFA
- The cost of daily care ($117.10) was 10% more than Medicare reimbursement. Source: 2001 report on the cost of routine home care in 1999 for Medicare hospice patients, conducted by Milliman USA for NHPCO
