By Chris Rawlings, Chief Executive Officer, HospiceCare( HospiceCare, The PalliativeCare Center, and Home Health of West Virginia)
The way we care for patients with serious illnesses is undergoing a profound transformation. Across the United States, and here in West Virginia, health systems and community providers are increasingly shifting critical aspects of care from the hospital to the home. This transition allows for prioritization of comfort, continuity of care, and quality of life, while honoring patient preferences. At HospiceCare and our affiliated services, The PalliativeCare Center and Home Health of West Virginia, we are living this transition daily, guided by emerging evidence that earlier, coordinated, home-based care yields better outcomes, higher satisfaction, and more efficient use of resources.
Hospital Discharge and the Rise of Home-Based Care
The transition from acute hospitalization to community-based care is one of the most consequential inflection points in a patient’ s health journey. Nationwide, more than 2.7 million hospitalized Medicare beneficiaries( ≈21 %) received a home health referral in 2022, yet the fulfillment of those referrals has been declining from 66 % in 2016 to 59 % in 2022 1. This decline results in many patients without needed care after discharge.
Home health services have demonstrable positive impact on outcomes. In a study of Medicare Advantage beneficiaries discharged after hospitalization, those who received home health care within 30 days showed lower mortality at 30 days( 2 % vs. 3 %), 90 days( 8 % vs. 10 %), and 180 days( 11 % vs. 14 %) compared with those who did not receive home health care 2. While home health patients in some studies exhibit slightly higher readmission rates than comparison groups, these settings often reflect appropriate detection and management of clinical changes, highlighting the need for robust care coordination and family education to prevent avoidable returns to acute care.
This data underscores an imperative: optimizing the discharge pathway with well-resourced home health services not only aligns with patient preferences to remain at home, but it also measurably reduces short- and mid-term mortality after hospitalization.
From Hospital to Home: Advancing Patient-Centered Care Across the Continuum
At HospiceCare, The PalliativeCare Center and Home Health of West Virginia, we are living this transition daily, guided by emerging evidence that earlier, coordinated, home-based care yields better outcomes, higher satisfaction, and more efficient use of resources.
Hospice Today: Timeliness, Length of Stay, and Satisfaction
Hospice remains a cornerstone of high-quality, patient-centered care at the end of life. Yet persistent challenges exist in ensuring referrals occur early enough to deliver the full benefit. National data indicates that roughly 65 % of hospice patients are enrolled within the last 30 days of life, with nearly 28 % enrolled in the final seven days, limiting the time patients benefit from hospice services 3.
Overall, approximately 1.6 million patients received hospice care in the U. S. in 2022, and about 48 % of Medicare decedents utilized hospice services 4. Despite these increases in utilization, the median length of stay hovers near 21 days 5, well below the 30-day mark identified by quality experts as a threshold for substantial benefit.
When hospice referrals occur earlier and patients remain in hospice longer, caregivers report higher satisfaction and better symptom management, including pain control, dyspnea treatment, and attention to personal values and beliefs. Recent Centers for Medicare & Medicaid Services( CMS) quality data show that over 95 % of hospice patients receive pain and dyspnea screenings, and more than 98 % report that preferences and values are addressed 6.