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End-of-Life Care Homes

October 15, 2021
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WRITTEN BY Dr. Jill Barnas

Hospice care is an interdisciplinary end-of-life healthcare approach that focuses on quality of life when a patient is terminally ill and a cure is no longer possible. Hospice care can be delivered at  a variety of locations, including the home or in home-like hospice residences, nursing homes, assisted living facilities, veterans' facilities, and hospitals. While hospice care is often fully covered by Medicare, Medicaid, and private insurance companies, the care is often provided by family members. Families may face additional out-of-pocket costs when hiring an in-home nurse or placing the family member in a nursing home to receive adequate care. Proposed 2021 legislation (HB 632) seeks to add End-of-Life Care Homes, a relatively new strategy in hospice care, into RSMo 198.190 to operate as registered care facilities.


  • Hospice patients can be any age with any terminal illness, however, most patients who enter hospice care are seniors (greater than 65 years old).
  • In Missouri, 17.3% of the population are seniors.
  • At the time of death, 1 out of 2 Medicare beneficiaries were in hospice care programs.
    • End-of-Life Care Homes provide a home-like dwelling for terminally ill individuals and supplemental care by non-medical volunteers at no cost when familial caregivers cannot be fully available.
    • Almost 9% of seniors live below 100% of the poverty level and may not be able to afford out-of-pocket costs associated with hospice care.
  • In recent years, hospice use has slowly increased for a variety of reasons including accessibility and eligibility.
  • Hospice reduces other expensive health care costs including hospital visits.


  • End-of-Life Care Homes are relatively new hospice care strategies; research investigating their effectiveness, including quality of care, has yet to be completed.
  • Hospice care research investigations about how to best provide end-of-life care in terms of both quality of life and cost effectiveness are ongoing.
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