Average Hospice Length of Stay
The median length of stay for hospice patients is approximately 17-18 days, with the average (mean) being only 9 days, reflecting the persistent problem of late referrals that prevent patients from receiving the full benefit of hospice care. 1
Current Statistics on Hospice Duration
The most comprehensive data from the NCCN Guidelines reveals concerning patterns:
- Median length of stay: 17.4 days in 2014 1
- Average (mean) length of stay: 9.1 days among Medicare beneficiaries with cancer (2010 data) 1
- Approximately 36% of patients die or are discharged within 7 days of hospice admission 1
- Only 43.3% of Medicare cancer patients accessed even 3 or more days of hospice care by 2007 1
Why This Matters for Patient Outcomes
Hospice care is strongly associated with improved quality of life, reduced symptom burden, and better achievement of end-of-life wishes, but these benefits require adequate time in hospice to be realized. 1
The evidence demonstrates that hospice enrollment leads to:
- Significantly lower hospitalization rates 1
- Fewer ICU admissions and invasive procedures 1
- Important improvements in both patient and caregiver quality of life 1
- Lower healthcare costs in the last year of life 1
The Core Problem: Late Referrals
Despite hospice eligibility requiring a prognosis of less than 6 months, most patients are referred far too late for hospice to provide its full benefit. 1
The NCCN Guidelines emphasize that this underutilization stems from:
- Physicians not recommending hospice early enough 1
- Marked variation in referral patterns between individual physicians (some averaging 36 days length of stay, others only 4 days for the same patient population) 1
- Patients dying between the time of hospice referral and actual enrollment 1
Clinical Implications
When a patient's functional status indicates a 6- to 12-month prognosis, initiate hospice discussions immediately rather than waiting for further decline. 1
Key action points:
- Schedule a dedicated "hospice information" visit when prognosis reaches 6-12 months 1
- Refer to hospice agencies as the first intervention for patients with months-to-weeks life expectancy 1
- Recognize that educational interventions and quality improvement measures can double hospice length of stay 1
Common Pitfall to Avoid
The most critical error is waiting until the patient is actively dying before initiating hospice discussions. One-third of hospice patients with cancer die after a length of stay of 7 days or less, which is insufficient time for hospice services to meaningfully impact quality of life or achieve patient end-of-life goals. 1