Our Hospice System Subverts the Very Point of Hospice Care
[Special thanks to Joel C. Dobris (Professor of Law, UC Davis School of Law) for bringing this article to my attention.]
In 2021, the Smith family made the decision to place their father in home hospice care during the final stages of Alzheimer’s disease, hoping to give him a dignified and comfortable end-of-life experience. They soon discovered that hospice care at home required far more involvement than they had anticipated. After enrolling in a Medicare-approved hospice program, most of the daily responsibilities, including bathing, feeding, administering medication, and managing pain, fell on the Smith siblings. Professional support was limited, with nurses visiting only briefly a few times a week, and additional in-home assistance was difficult to obtain.
The Smith family came to understand that limited Medicare funding was a central issue within the hospice system. Hospice agencies receive about $200 per day per patient, which must cover medications, equipment, and staffing. This leaves little room for consistent, hands-on care. As a result, the Smith siblings were expected to take on complex and emotionally difficult medical tasks themselves. Their experience highlights how gaps in support can affect both the patient’s comfort and the emotional well-being of loved ones providing care.
Ultimately, the Smith family’s experience reflects broader problems within the hospice system, which often falls short of its original goals of reducing suffering, preserving dignity, and supporting both patients and families. Financial limitations, the rise of for-profit hospice providers, and a heavy reliance on unpaid family care all contribute to these shortcomings. Although the Smith siblings were able to manage due to their resources and medical knowledge, many families are not as fortunate. Their story underscores the need for increased funding and more in-home support to improve end-of-life care and reduce reliance on hospital stays.
For more information see Sandeep Jauhar “Our Hospice System Subverts the Very Point of Hospice Care,” The New York Times, March 2, 2026.