What Is The Average Amount Of Time People Live In Hospice Care?

In its page on common misconceptions, Mission Hospice & Home Care says, "Hospice care neither hastens death nor prolongs life." The goal when a patient enters into hospice is management and comfort. For those whose life expectancy can be measured in months or less or those who've long experienced chronic conditions that can't be cured, enhancing their remaining time on Earth sometimes becomes a greater priority than prolonging it.

Hospice care is on the rise in the United States. Hospice care has no ironclad rules governing who receives it and when it ends, but public and private insurers in the American health system will generally ask that at least two doctors indicate hospice's value — they believe the patient likely has six months or less to live — before they provide coverage. In a Journal of Palliative Medicine study of over 126,000 patients admitted to 10 hospices, that is the time frame in which 90% of hospice patients passed away. Of that percentage, around 50% died within three weeks, and around 35.7% died within one.

And yet, according to the National Hospice and Palliative Care Association (NHPCO), the average stay in hospice care in 2017 was 76.1 days. And those that live past six months while in hospice still represent a significant minority. A number of factors influence the time a person might spend in hospice care, from age and sex to the various stigmas that surround hospice and its associations with the end of life.

Time of death varies among hospice patients by several factors

Hospice care's association with the end of life can feed negative myths about it. Providers like Mission Hospice and others often have pages devoted to refuting such myths. It's not true, for instance, that the choice to receive hospice care can't be reversed. Hospice care also doesn't mean a patient surrenders their doctors or medicines. Death remains a frightening prospect for most, however, and research in the Journal of Pain and Symptom Management suggests that family caregivers with loved ones in hospice are more likely to be exposed to unsettling end-of-life situations than those caring for people without hospice.

Such experiences and fears may play a role in the average life expectancy of those who enter hospice care. Among other stigmas attached to it, there's a perception among some patients, families, and doctors that such a step would be "giving up," making patients reluctant to enter hospice and doctors reluctant to suggest it. But many families with the experience behind them have said they wished their loved ones had started hospice sooner, expressing gratitude for the care and comfort shown.

A patient's age, sex, and the nature of the condition that led them to hospice care can also influence how long they stay in it. An examination of hospice patients for the Journal of Palliative Medicine found that patients under the age of 65 were more likely to live past six months — by around a 10% difference. It also found that patients experiencing dementia or debility had even greater odds of living past six months compared to those with cancer or cardiovascular disease.

There are no hard and fast rules for entering hospice care

Insurance providers may need a doctor's opinion that a patient is unlikely to live past six months before they'll cover the cost of hospice, but no one can predict the time of death that precisely. Contrary to some expectations, there is limited evidence that hospice care can end up helping patients live longer, at least for those with certain illnesses. One study in the Journal of Pain and Symptom Management found that lung and pancreatic cancer and congestive heart failure patients had significantly extended survival rates while in hospice care (breast and prostate cancer survival rates appeared unaffected).

Patients who end up living past the sixth-month marker may be eligible to renew their hospice coverage. Renewal, however, depends on the circumstances. Generally, renewal requires a doctor's assessment that living another six months is unlikely. If a patient sees significant improvement in their condition to the point where it is no longer considered terminal, they are often considered ineligible for hospice care. Patients can also choose to resume regular treatment at any time, for any reason. And hospices have the right to discharge abusive or dangerous patients, though it's a rare occurrence.