Family Referrals = Longer Hospice LOS

Hospice referrals made directly from families (sometimes called “direct referrals” or “self referrals”) result in 7-9 days longer lengths of stay than referrals from other sources. These data were gathered by Transcend Hospice Marketing, a nationally renowned firm that is deeply steeped in research and is very results-oriented. (My kind of approach!)

National Stats

According to the most recent factsheet of the National Hospice and Palliative Care Organization, the median length of stay was 17.4 days. Put in a different way, 50.3% of patients died or were discharged within 14 days of admission. More than 1/3 of patients (35.5%) died or were discharged within just 7 days (one week!) of admission.


A short LOS (Length of Stay) is a concern for hospice on two levels.

Patient Care

Studies have shown that patients and families receive the most value (services, satisfaction, etc.) if they are on service for at least 60 days. Of course no one has a crystal ball for guessing prognosis. But what patients and families don’t realize is that they actually have 6 months of benefits available. More if warranted. Most families, once they receive hospice care, say they wish they had been referred earlier.


It costs a lot to get a patient/family on-boarded to hospice. Even with a U-shaped adjustment to the pay schedule, the front-loaded costs of admission make short stays financially hazardous. Look at the figure that 35.5% of patients end up dying or being discharged within one week of starting service. Quite candidly, that’s just not enough time to recoup the initial expenses of staff time, equipment and supplies.

Direct-from-family referrals

Certainly a doctor’s order is required for admission. But hospice is unique in that patients or families can request a referral. Whether it is through you directly, or they make the request to the doctor, those referrals tend to result in admissions. And as the Transcend data reveal, longer lengths of stay.

Area of greatest growth potential

At Elder Page Online, we have 90 clients throughout the country. In my work with hospices nationwide, I find that they focus almost entirely (90-95%) on marketing to referrers. Direct-from-family referrals make up only 5-10% of their admissions. Marketing to families does require a shift in focus.

The good news is that this is an untapped area where you as a hospice have the greatest potential to grow. (Some hospices have gotten up to 30-40% family self-referrals.) Plus, there is not a lot of competition. While everyone else is bringing donuts and pens to the doctor’s office, you can focus on the families and have the field wide open.

Marketing to families

Families need to be educated that hospice, and palliative care if you provide it, is not just for the end of life. That is too short a time-frame in the public mind (appropriate only for the last few days). A poll by the Center to Advance Palliative Care revealed that the time-window of opportunity falls more in the category of what the public calls “serious illness.” Your job as a marketer, therefore, is to expand community awareness so that your are seen as more than the expert in end-of-life care. You need to be seen, instead, as the experts in serious illness and family caregiving.

The Internet is where families are going

No one likes to think about a loved one’s dying. But family caregivers turn to the Internet for information to support them along their caregiving journey. Meet them where they are going, and meet them earlier in the process. We can help you with branded content marketing materials that position you as the experts in serious illness and family caregiving:

If you’d like to explore growing your direct-from-family referrals, give us a call at 707-477-0700, or email me at We’d be delighted to help.

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