More Dying ICU Patients Are Choosing Hospice — And a New Study Shows How Fast That’s Changed

A new study tracking more than a decade of Medicare data shows a striking rise in the number of older adults who leave the intensive care unit and go directly to hospice — and researchers say the shift likely reflects a broader change in how Americans approach the end of life.

Between 2011 and 2023, more than 10.6 million Medicare beneficiaries were admitted to ICUs across the country. During that period, hospice discharges following an ICU stay climbed from 388 to 572 per 100,000 Medicare beneficiaries — a meaningful jump that researchers say can’t be explained away by rising mortality rates alone.

That last part is key. The 30-day mortality rate among ICU patients held steady throughout the study period. In other words, people aren’t dying at higher rates after leaving the ICU. They’re choosing — or their families are choosing — to move into hospice care instead of continuing aggressive treatment.

A Shift in End-of-Life Culture

Published in the Annals of the American Thoracic Society, the study analyzed Medicare’s Provider Analysis and Review and Master Beneficiary Summary Files to track adults 65 and older enrolled in fee-for-service Medicare for at least a year.

The researchers were careful to flag one important limitation: the data only captures patients who formally enrolled in hospice. The actual number of people who transitioned to comfort-focused care — without a formal hospice designation — is almost certainly higher.

“These findings reveal rapidly evolving patterns of end-of-life healthcare utilization among older adults in the US, which may inform policymakers’ and health systems’ future infrastructure planning,” the authors wrote.

What It Means for Nursing Homes and Long-Term Care

The findings carry real implications for skilled nursing and long-term care providers. As more patients move from the ICU into hospice, facilities can expect a growing share of admissions to come from patients who are already in the final stages of serious illness — often with complex pain management needs, family dynamics, and limited time.

It’s also a signal that goals-of-care conversations are happening earlier and more often — a trend many palliative care advocates have pushed for years. Whether that’s the result of better communication from hospital teams, shifting cultural attitudes around death, or greater awareness of what hospice actually offers, the data shows it’s working.

The study’s authors say the trend should prompt health systems and policymakers to invest in the infrastructure needed to meet growing hospice demand — from staffing to facility capacity to how end-of-life care gets reimbursed.

“Given the rising use of hospice after critical illness,” they noted, “our findings also highlight the importance of examining outcomes after hospice to guide future efforts to improve end-of-life care.”