In the United States, hospice care is increasingly delivered in the home setting, reflecting both patient preference and a growing body of clinical evidence supporting its effectiveness. For physicians guiding patients and families through end-of-life decisions, understanding the outcomes associated with hospice at home is essential. Questions sometimes arise regarding whether hospice at home can provide care comparable to inpatient settings, particularly with respect to survival, symptom control, and overall quality of care. The evidence below helps inform those discussions and offers reassurance when hospice at home is the preferred option.
In the U.S., most hospice care is delivered in the home setting. Most patients prefer home as their place of death.¹ Indeed, dying at home is associated with higher care satisfaction.² Moreover, greater lengths of stay in home-based palliative care are associated with greater improvements in survival,³ more effective symptom management,⁴ improved mental health status among loved ones,⁵ and greater cost savings for both patients and payors.⁶ However, compared to care available in inpatient settings, patients, and even their physicians, may occasionally have concerns that hospice at home would not be able to match inpatient palliative care and that, as a result, lives would be shortened.
Fortunately, a growing number of studies provide data to inform hospice setting decisions. This evidence and clinical experience can lend reassurance to patients who prefer to receive hospice at home. A recent contribution to this body of evidence is a study published in BMJ Supportive & Palliative Care.⁷
Researchers followed nearly 9,000 hospice patients and created risk-adjusted comparisons of survival between different hospice settings: home, hospital, and multi-setting. Overall, hospice setting did not significantly affect survival in patients with cancer. No statistically significant differences were observed across head and neck, colorectal, or hepatocellular carcinoma. There was one notable exception. Among patients with advanced lung cancer, those who received hospice at home had a statistically significant survival advantage. Lung cancer patients receiving hospice at home had a risk-adjusted 25% lower risk of death during the study period compared to those receiving inpatient or multi-setting hospice. This finding provides encouraging evidence that hospice at home is not inferior to inpatient hospice care.
The current study adds to previous research comparing survival in hospice at home to other settings. Jun Hamano, MD, and colleagues prospectively followed 2,069 cancer patients with prognoses measured in days, weeks, or months.⁸ They compared patients receiving palliative care in hospitals with patients receiving hospice at home. Among patients whose prognosis was a few days, hospice at home correlated with a 44% longer survival. Among patients whose prognosis was measured in months, hospice at home correlated with a 24% longer survival.
It is also noteworthy that when prognosis is six months or less, survival among patients receiving hospice at home is not inferior to that of patients receiving cure-directed care.⁹⁻¹¹ Additionally, there appears to be a dose-response relationship, in which patients referred to hospice later realize a smaller benefit compared to those referred earlier. Hospice is designed to provide up to six months of service, allowing sufficient time for comprehensive symptom management and support.
The preponderance of evidence associates hospice with lives lengthened by days to weeks. Of course, hospice neither seeks to lengthen nor shorten life. Rather, hospice focuses on symptom control, dignity, and quality of life during the final months. Survival data help reassure patients and physicians alike that hospice at home delivers high-quality palliative care without compromising outcomes.
Avatar Home Health and Hospice: Supporting Hospice at Home
For physicians considering hospice referrals, the setting matters—but so does the provider. The evidence supports hospice at home as a safe and effective option for many patients, including those with advanced illness. Avatar Home Health and Hospice brings nearly two decades of experience delivering hospice at home, supported by Joint Commission accreditation, Medicare certification, interdisciplinary clinical teams, and strong community partnerships. By combining evidence-based hospice care with a deep commitment to patients, families, and referring physicians, Avatar Home Health and Hospice is well positioned to support meaningful, patient-centered end-of-life care in the home setting.
Avatar is a We Honor Veterans Partner
As a proud partner of the We Honor Veterans program, Avatar Home Health and Hospice demonstrates a deep, systematic commitment to serving those who have served our nation. The We Honor Veterans initiative, developed in collaboration with the National Alliance for Care at Home and the Department of Veterans Affairs, equips our interdisciplinary care teams with veteran-centric training, resources, and best practices that promote respectful inquiry, compassionate listening, and grateful acknowledgment of military service. We Honor Veterans | This partnership enhances our ability to recognize and address the unique clinical, emotional, and psychosocial needs of veteran patients and their families at the end of life, strengthens our collaboration with VA facilities and veteran organizations, and increases access to supportive hospice services that honor service and sacrifice. (We Honor Veterans Hospice Partners) For referring physicians, this offers confidence that your veteran patients will receive not only the highest quality care but also personalized acknowledgment of their service, thoughtful support in navigating benefits, and a more meaningful, patient-centered transition to hospice care.
References
- Gomes B, Calanzani N, Gysels M, Hall S, Higginson IJ. Heterogeneity and changes in preferences for dying at home: a systematic review. BMC palliative care. 2013 Dec;12(1):1-3.
- Regier NG, Cotter VT, Hansen BR, Taylor JL, Wright RJ. Place of Death for Persons With and Without Cognitive Impairment in the United States. Journal of the American Geriatrics Society. 2021 Apr;69(4):924-31.
- Hamano J, Yamaguchi T, Maeda I, Suga A, Hisanaga T, Ishihara T, Iwashita T, Kaneishi K, Kawagoe S, Kuriyama T, Maeda T. Multicenter cohort study on the survival time of cancer patients dying at home or in a hospital: Does place matter?. Cancer. 2016 May 1;122(9):1453-60.
- Cheraghlou S, Gahbauer EA, Leo-Summers L, Stabenau HF, Chaudhry SI, Gill TM. Restricting symptoms before and after admission to hospice. The American Journal of Medicine. 2016 Jul 1;129(7):754-e7.
- Bradley EH, Prigerson H, Carlson MD, Cherlin E, Johnson-Hurzeler R, Kasl SV. Depression among surviving caregivers: does length of hospice enrollment matter?. American Journal of Psychiatry. 2004 Dec 1;161(12):2257-62.
- Rice DR, Hyer J, Diaz A, Pawlik TM. End-of-Life Hospice Use and Medicare Expenditures Among Patients Dying of Hepatocellular Carcinoma. Annals of Surgical Oncology. 2021 Sep;28(9):5414-22.
- Lai WS, Liu IT, Tsai JH, Su PF, Chiu PH, Huang YT, Chiu GL, Chen YY, Lin PC. Hospice delivery models and survival differences in the terminally ill: a large cohort study. BMJ Supportive & Palliative Care. 2024;14:e1134–e1143.
- Hamano J, Yamaguchi T, Maeda I, et al. Multicenter cohort study on the survival time of cancer patients dying at home or in a hospital: Does place matter? Cancer. 2016 May; 122 (9): 1453-60.
- Regier NG, Cotter VT, Hansen BR, Taylor JL, Wright RJ. Place of Death for Persons With and Without Cognitive Impairment in the United States. Journal of the American Geriatrics Society. 2021 Apr;69(4):924-31.
