Decline in Hospice Utilization Rates: Unpacking the Causes and Implications

In recent years, hospice utilization rates have experienced a noticeable decline, despite the total number of patients remaining steady. This trend has raised questions and concerns within the healthcare community. Understanding the factors behind this decline is crucial for healthcare providers, policymakers, and families alike.

Demographic Shifts

One primary factor contributing to the decline in hospice utilization rates is the shifting demographics of the aging population. The overall number of elderly individuals is increasing, which theoretically should lead to higher utilization rates. However, the percentage of Medicare beneficiaries opting for hospice care has not kept pace with this demographic growth. In 2021, approximately 47.3% of all Medicare decedents received at least one day of hospice care, a figure similar to that of 2020, despite the total number of patients served increasing slightly from 1.71 million to 1.72 million.

Impact of the COVID-19 Pandemic

The COVID-19 pandemic significantly disrupted healthcare services, including hospice care. The rapid and severe nature of the virus, particularly among vulnerable seniors, led to many deaths before patients could elect hospice care. Additionally, many individuals who might have sought hospice for other conditions succumbed to COVID-19 instead.

The pandemic also caused broader disruptions in the healthcare system. Hospitals and health systems had to pivot their resources towards managing the outbreak, which affected their ability to provide routine care. This shift, coupled with stay-at-home orders and social distancing measures, led many patients to delay or forego necessary medical treatments, including hospice care. These disruptions have had a lingering impact on hospice utilization rates, even as the immediate crisis has subsided.

Long-term Effects of Pandemic Disruptions

The effects of the pandemic on hospice utilization rates are expected to persist. Patrick Harrison, Senior Director of Regulatory and Compliance for the National Hospice and Palliative Care Organization (NHPCO), noted that while the public health emergency has ended, the repercussions of COVID-19 continue to influence hospice care decisions. The healthcare system’s adjustment period means it will take time for hospice utilization rates to rebound fully.

Changing Perceptions and Preferences

Another factor influencing hospice utilization rates is changing perceptions and preferences regarding end-of-life care. Some patients and families may have concerns about the quality of care in hospice settings, particularly in light of the pandemic. Additionally, cultural and personal preferences play a role in whether individuals choose hospice care. For some, there may be a preference for aggressive treatment options or a desire to spend their final days at home without formal hospice services.

Efforts to Address the Decline

Recognizing these challenges, healthcare providers and policymakers are working to address the decline in hospice utilization rates. Efforts include improving public awareness and understanding of hospice care, addressing misconceptions, and ensuring that hospice services are accessible and of high quality. Additionally, there is a focus on integrating hospice care more seamlessly into the broader healthcare system to ensure that patients can make informed choices about their end-of-life care.


The decline in hospice utilization rates is a multifaceted issue influenced by demographic changes, the COVID-19 pandemic, healthcare system disruptions, and changing patient preferences. As the healthcare community continues to adapt to these challenges, it is crucial to prioritize the needs and preferences of patients and their families. By addressing the underlying factors contributing to the decline, we can work towards a more robust and responsive hospice care system that meets the needs of our aging population.

Hospice care remains a vital component of end-of-life care, providing comfort and support to patients and their families during challenging times. Ensuring that this care is accessible, understood, and utilized appropriately is essential for improving the quality of life for those in their final stages of life. As we navigate the post-pandemic landscape, continued efforts to support and enhance hospice care will be critical in reversing the decline in utilization rates and ensuring that patients receive the compassionate care they deserve.