When is it time for hospice? Most families wait too long

Your father’s doctor has stopped talking about the next treatment and started talking about comfort. Someone mentions hospice. Your first thought is that it is too soon.

For most families, it is already late.

How long do most families actually get hospice?

Medicare’s hospice benefit is for people whose hospice doctor, and their regular doctor if they have one, certify a life expectancy of six months or less if the illness runs its normal course, according to Medicare.gov.¹ Among Medicare beneficiaries who died in 2022 after using hospice, the median lifetime length of stay was 18 days, according to NHPCO’s Facts and Figures, 2024 edition.² One in four was enrolled for five days or less, according to the same report.²

About 1.72 million Medicare beneficiaries received hospice care in 2022, and 49.1 percent of Medicare beneficiaries who died that year had used the benefit, according to the same report.² Hospice reaches many families. It reaches most of them for days, when it was built to support them for months.

Why do families wait so long?

Three reasons, and the third costs families the most.

They believe hospice means giving up. It does not. Hospice means the goal of care shifts from curing to comfort. Comfort care is still care, and often more of it than your parent was getting.

Nobody tells them. Doctors are trained to treat. Prognosis conversations are hard, and the referral gets postponed one more visit at a time.

They think they need permission to ask. You do not. You can request a hospice evaluation yourself, without waiting for the doctor to raise it. Asking does not commit your parent to anything, and you can decline afterward.

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What does Medicare’s hospice benefit cover?

Hospice comes to your parent, usually at home. Under Medicare’s hospice benefit the team includes nurses on call around the clock, medications for comfort and symptom control, equipment such as a hospital bed, an aide for bathing and personal care, a social worker and a chaplain.¹ It also includes respite care, so the family caregiver can rest, and grief support for the family that continues after the death.

Choosing hospice is often the moment a parent finally gets more care, not less. The weeks families lose to waiting are weeks of nurses at the house, medication delivered, someone to call at 2 a.m., and support for the people doing the caregiving.

What should you do next?

1. Ask the doctor directly: “Would you be surprised if this were the last six months?” Doctors rarely raise hospice first. Families who ask, get answers.
2. Request a hospice evaluation yourself. Any Medicare-certified hospice can assess your parent, and the evaluation does not commit you to enrolling.
3. Confirm the hospice is Medicare-certified. Medicare.gov’s Care Compare tool lists Medicare-certified hospices, and 1-800-MEDICARE (1-800-633-4227) is Medicare’s help line.⁴
4. Ask the hospice three questions at the first meeting: what happens if my parent improves, how does recertification work after six months, and what does respite care for the family look like.
5. Bring your siblings into the conversation now, while there is still time to use the benefit as it was designed.

The waiting is the only part you cannot get back.