Despite the clear benefits of hospice care, many patients are referred very late – sometimes in their final days of life – limiting the opportunity to benefit from its full scope. Two of the most commonly cited reasons for this delayed referral are:

• Clinician-related delays: Research shows that physicians often struggle with prognostication, lack of training in hospice eligibility and goals-of-care conversations, and uncertainty about when to refer. For example, a study found that physicians had difficulty determining prognosis and eligibility, which directly contributed to delayed hospice referral.
• Patient/family preference for curative treatment or denial of serious illness: Many families view hospice as “giving up,” and patients may seek more aggressive or curative treatments until very late. One review noted that among patients who delayed hospice, factors included desire to exhaust all treatment options and misunderstanding of hospice’s role.

Together, these barriers contribute to the pattern of late admission to hospice, which can undermine many of the benefits that hospice care is designed to provide.

Hospice care plays an essential role in ensuring patients with serious illness receive appropriate, coordinated, and compassionate care near the end of life. Yet, despite its well-documented benefits, hospice care is often initiated too late to deliver its full value to patients, families, and the healthcare system.

The Impact of Hospice Care on Outcomes and Cost

A 2023 analysis conducted by an independent research organization examined Medicare data to evaluate the impact of hospice care on outcomes and costs. The findings provide a clear picture of why timely hospice enrollment matters.

Patients who enrolled in hospice experienced lower rates of hospitalization, fewer emergency department visits, and reduced use of intensive medical interventions in the final months of life. These patients also reported higher satisfaction with care and better symptom management. Family members experienced fewer adverse emotional and financial effects during and after the end-of-life period.

From a systems perspective, hospice care was associated with significant cost savings. The study found that Medicare spending in the last year of life was approximately 3% lower for patients who used hospice than for those who did not. For patients enrolled for longer periods – particularly six months or longer – total costs were reduced by as much as 11%. The analysis also showed that after approximately 11 days of hospice enrollment, cost savings began to outweigh the costs of care, emphasizing the importance of timely referral.

These findings reinforce a central principle of hospice care: early involvement leads to better outcomes. Short hospice stays, often measured in days rather than weeks or months, limit the ability of interdisciplinary care teams to manage symptoms, provide counseling, and effectively coordinate family support. Early referral allows the full hospice model – which integrates medical, emotional, and spiritual care – to operate as intended.

Bringing the Findings Into Practice

For healthcare providers, this evidence highlights the need to normalize early discussions about hospice eligibility. For families, it underscores the importance of understanding that hospice is not a signal of giving up but a shift toward comfort, coordination, and quality of life. For policymakers and payers, it demonstrates that strengthening the hospice care model can deliver measurable value across the healthcare continuum.

Hospice care remains one of the few interventions that simultaneously improves outcomes, supports families, and reduces overall healthcare spending. Ensuring that patients are referred early enough to experience those benefits should be a shared goal for clinicians, organizations, and communities alike.

References

• NORC Final Report: Value of Hospice in Medicare
• The Debate in Hospice Care
• Late Referral to Hospice and Bereaved Family Member Perception of Quality of End-of-Life Care
• Timing of Hospice Referral: Assessing Satisfaction While the Patient Receives Hospice Services
• Extent and determinants of error in doctors’ prognoses in terminally ill patients: prospective cohort study
• Prognostication