Why Do Nursing Homes Push Hospice?

When a nursing home suggests hospice care for your loved one, it can feel sudden, confusing, or even suspicious. You may question if the recommendation truly serves your relative's best interest or if other factors are at play.



Nursing homes encourage hospice for several reasons. Some are rooted in patient comfort and appropriate end-of-life care. Others relate to staffing realities, financial considerations, and regulatory pressures that facilities face.

Hospice itself is not inherently harmful or negative, but the timing and reasoning behind the referral matter significantly. In this article, we'll walk you through the difference between nursing homes and a hospice, and why the former sometimes pushes the latter as the better option. 

What Is the Difference Between a Hospice and a Nursing Home?

Nursing homes and hospice providers serve different purposes, though they often work together.

A nursing home is a residential facility that provides long-term custodial care for people who cannot live independently. Residents receive help with:

• Bathing, dressing, and personal hygiene
• Eating and medication management
• Daily activities and mobility support
• Chronic condition monitoring

The focus is on maintaining quality of life and managing chronic conditions.

Hospice takes a different approach. It's a philosophy of care focused on comfort rather than cure, designed for people with terminal illnesses who have a life expectancy of six months or less. Hospice prioritizes:

• Symptom management and pain relief
• Emotional and spiritual support
• Dignity at the end of life
• Family counseling and bereavement care

Hospice is not a place.

In most cases, it's a service that comes to wherever the patient lives. This means hospice care can be provided inside a nursing home. When someone in a nursing center enrolls in hospice, the nursing home continues to provide room, board, and basic care, while the hospice team adds specialized end-of-life support, medications, equipment, and additional staff visits.

At What Point Do They Put Someone on Hospice?

Hospice eligibility is based on medical criteria, not on age, diagnosis, or where someone lives.

To qualify, a physician must certify that the person has a terminal illness and a prognosis of six months or less if the disease follows its expected course. Certification requires documentation of decline, which might include:

• Weight loss and decreased appetite
• Increased infections or repeated hospitalizations
• Reduced mobility or bedridden status
• Worsening cognitive function
• Symptoms that no longer respond to treatment

The decision is based on clinical judgment and established guidelines for specific conditions like advanced dementia, heart failure, or cancer.

A person does not have to wait until they are actively dying to enroll in hospice.

Many families delay too long, missing out on months of comfort care. The goal is to begin hospice when the focus shifts away from aggressive treatment and toward comfort and quality of remaining time.

Why Do Nursing Homes Move People to Hospice?

Nursing homes often recommend hospice because it can improve care and reduce the burden on their own staff.

When a resident is declining, they may require more frequent monitoring, symptom management, medication adjustments, and emotional support than the facility can easily provide.

Bringing in a hospice team adds specialists who visit regularly:

• Nurses for symptom assessment and medication management
• Aides for personal care assistance
• Social workers for counseling and family support
• Chaplains for spiritual care
• Volunteers for companionship

This extra layer of support can be genuinely beneficial for residents and families.

However, it also means the nursing home can transfer some care responsibilities to an outside provider, which eases workload pressures on their staff. Several operational and systemic factors influence why nursing homes push hospice, including chronic understaffing, financial incentives, and regulatory concerns about mortality rates and hospitalizations.

What Financial Incentives Are Involved When Nursing Homes Push Hospice?

When a nursing home resident enrolls in hospice, Medicare (or other insurers) pays the hospice agency to cover all services related to the terminal diagnosis. This includes:

• Medications for pain and symptom management
• Medical equipment like hospital beds and oxygen
• Nursing visits and assessments
• Supplies for wound care and personal hygiene

The nursing home no longer bears these costs.

For facilities operating on tight margins, this cost shift can be significant. Medications for pain management, wound care supplies, oxygen equipment, and frequent physician visits can add up quickly. Hospice assumes financial responsibility for these items, which saves the nursing home money.

Some facilities also receive referral fees or have formal partnerships with specific hospice agencies. While these arrangements are supposed to be transparent and ethical, they can create conflicts of interest.

The decision to recommend hospice should always be based on the resident's medical needs, not on financial arrangements between providers.

Families should feel comfortable asking who pays for what once hospice begins and whether the facility has any business relationships with the hospice agency being recommended.

Is Hospice Always the Right Choice When a Nursing Home Suggests It?

No. Hospice is not a one-size-fits-all solution.

The fact that a nursing home recommends it does not automatically mean it is appropriate or necessary. Every person's situation is unique, and the decision should be based on their specific medical condition, prognosis, values, and preferences.

Some residents may be suggested for hospice prematurely. They may still be relatively stable, able to engage in activities, or responsive to treatment. In these cases, hospice may not be the right fit yet.

Other times, the recommendation may be genuinely appropriate, but it is presented poorly or without adequate explanation, leaving families feeling pressured or confused.

Families have the right to ask questions:

• Why is hospice being recommended at this particular time?
• What has changed recently?
• What symptoms or decline have been observed?
• What are the alternatives?
• What happens if hospice is declined?

You are not required to agree to hospice simply because it is suggested. You can request a second opinion, ask for more time, or explore other options.

The decision should always prioritize the resident's best interests.

What Are the Signs That Hospice Is Truly Needed?

Certain clinical indicators suggest that hospice is appropriate and beneficial. These signs go beyond vague statements like "they're declining" and point to specific, observable changes that indicate a person is nearing the end of life.

Physical Decline

Frequent or recurrent infections that no longer respond well to antibiotics can signal that the body's systems are failing. Significant, unintentional weight loss despite adequate nutrition may indicate that the body is shutting down. Progressive difficulty swallowing, breathing, or maintaining consciousness suggests advanced disease.

Medical Interventions No Longer Help

Repeated hospitalizations for the same issue, especially when treatments offer only temporary relief, may indicate that aggressive interventions are no longer helping. Similarly, when symptoms like pain, shortness of breath, or agitation become difficult to control with standard nursing home care, hospice's specialized expertise can make a meaningful difference.

Functional Changes

Functional decline is also key. Look for these changes:

• Stopped walking or became bedridden
• No longer eating independently or refusing food
• Stopped recognizing family members
• No longer responding to their environment
• Progressive and irreversible loss of abilities

If these changes are progressive and irreversible, it may be time to shift the focus from rehabilitation to comfort.

These are the kinds of concrete, patient-centered indicators that should drive hospice conversations, not financial or operational concerns on the facility's part.

How Can Families Advocate for the Right Hospice Decision?

Start by asking direct, specific questions:

• Why is hospice being recommended now?
• What symptoms or changes have been observed?
• What is the prognosis?
• What happens if we wait?
• What are the alternatives?

Request a care conference with the nursing home staff, the attending physician, and a representative from the hospice agency. This meeting allows everyone to share information and ensures you have a full picture of your loved one's condition.

Get a Second Opinion

If you are uncertain, seek a second opinion from an outside physician who specializes in geriatrics or palliative care. They can review medical records and offer an independent assessment of hospice appropriateness.

Choose Your Own Provider

You have the right to choose your own hospice provider. If the nursing home recommends a specific agency but you prefer another, you can make that choice. Research hospice providers in your area, read reviews, and ask about:

• Services offered and visit frequency
• Availability of after-hours support
• Staff credentials and experience
• Philosophy of care

Remember It's Not Permanent

Hospice enrollment is not irreversible. If you try it and it does not feel right, or if your loved one's condition improves, you can disenroll. The decision is not final, and you can change course if needed.

Finally, involve your loved one in the decision as much as possible. If they are still able to communicate their preferences, honor their wishes. Their values, beliefs, and desires should guide the choice.

When You Have Questions, Valley Oaks Hospice Is Here to Listen

If a nursing home has suggested hospice and you’re feeling uncertain about the reasons or the timing, you don’t have to sort through those concerns on your own. The team at Valley Oaks Hospice is here to help you understand your options clearly and without pressure.

We take the time to review your loved one’s condition, explain what hospice would involve in their specific situation, and answer the questions nursing homes don’t always slow down to address. Our focus is on comfort, dignity, and care decisions that truly align with your family’s values, not convenience or cost.

If you want an honest conversation about whether hospice is appropriate right now, or simply need guidance navigating a recommendation from a facility, reach out to Valley Oaks Hospice today. Compassionate support starts with a conversation, and we’re here whenever you’re ready.