The Medicare Hospice Benefit's Origins: Lessons on End-of-Life Caregiving

Legislation in 1982 formalized hospice care as a Medicare-reimbursed service. In the years that have followed, while many Americans have benefited from hospice's holistic, comfort-focused care, Medicare reimbursement frequently prevents hospices from providing the degree of caregiving support that patients and their informal caregivers need. Prior to the Medicare Hospice Benefit, leaders of the hospice movement emphasized that informal caregivers need significant support at the end of life, including custodial support through options for facility-based care for dying patients. The Medicare Hospice Benefit was designed to contain healthcare spending, resulting in a structure of care that curtailed caregiving support. This history illustrates key themes that remain relevant to public discourse today, including the extent to which payers should provide caregiving support and the role of facilities in providing custodial care at the end of life.