Hospice Administrator – A Day in the Life

Hospice administrators oversee the operations of a hospice agency. While a nursing home or a long-term care facility will focus on patient longevity, hospice services are provided to people who are believed to be in their last six months of life. As such, the care here is less about prevention and recovery—and more about comfort and peace of mind.

Rather than seeking out cures, the hospice philosophy prioritizes the concept of care. Hospices are dedicated to supporting the patient, and the patient’s family, in their physical, mental, emotional, spiritual, and social needs. Hospice administrators, therefore, are experts at managing end-of-life care, taking into account both pragmatism and compassion.

Due to the demographic warp of the aging Baby Boomer generation, hospice facilities and hospice administrators are expected to be in greater demand in the near future. As part of the broader category of medical and health services managers, the Bureau of Labor Statistics (BLS 2025) expects jobs in this field to grow 29 percent between 2023 and 2033—a rate that’s seven times faster than the national average for all professions.

Everyone who needs end-of-life care deserves quality end-of-life care. And while it may be a topic that the average person spends most of their time avoiding, it’s something that hospice administrators dedicate their lives to achieving. Read on to get a glimpse into a day in the life of a hospice administrator.

Amy Tucci is president and CEO of Hospice Foundation of America (HFA), a charitable organization that educates professionals and the public about care at the end of life. She began work with Hospice Foundation of America in 2004, directing its national annual Living with Grief® educational event and overseeing its Washington, DC office. She has produced a number of educational programs on advanced illness care and grief, and has edited numerous books on topics involving end of life, including ethics; pain management; child and adolescent grief; grief theory; diversity, and spirituality.

In her role as president and CEO, Tucci also directs HFA’s fundraising, grant projects, and operations. Prior to joining HFA, Amy served as a press secretary on Capitol Hill for the Committee on Ways and Means, as vice president of the Alliance of Community Health Plans, and as director of communications and membership for the American Public Human Services Association. She is a graduate of the University of Pennsylvania and formerly served on the Board of Consultors for the Villanova University College of Nursing.

Angela Novas is the chief medical officer at Hospice Foundation of America. She graduated from The George Washington University, Washington, DC, with an MSN in nursing/adult-gerontology primary care nurse practitioner (ANCC).

Novas completed her postgraduate studies in palliative and hospice care, including Practical Aspects of Palliative Care (PAPC), at Harvard Medical School. She received her palliative care certificate from the University of Colorado and completed her board certification as an Advanced Certified Hospice & Palliative Care Nurse (ACHPN).

MHAOnline.com: What’s something you wish the public understood about hospice care?

Tucci and Novas: We want people to understand many things about hospice. First is that hospice care is as much about how you want to live as it is about how you want to die. Many people believe that hospice care is available only during the active dying phase, when it is actually available to anyone with a life expectancy of six months or less. The earlier you can take advantage of hospice, the more time hospice has to support you, giving you time to enjoy friends, family, pets, home, and other things that are meaningful. Hospice can manage symptoms related to an incurable illness, such as pain, shortness of breath, nausea, and anxiety, and provide holistic care for family caregivers and loved ones.

Second, we want people to know that they should not wait for their attending physician to recommend hospice care. Patients and/or families can self-refer to a hospice provider serving their community. Medicare eligibility requirements, which govern hospice care generally, require two doctors to agree that the person admitted to hospice care has a predicted lifetime prognosis of six months or less if the disease runs its expected course, but people can continue to receive hospice beyond six months once admitted. Unfortunately, many physicians defer assessment of their patients for hospice care until very late in the disease progression, depriving patients and family caregivers of the full range of hospice supportive services and benefits, including medications and durable medical equipment, and access to four levels of hospice care.

Third, we want people to know that hospice is fully covered by Medicare and private insurance as a packaged benefit unlike other forms of end-of-life care. Most hospice patients are eligible for Medicare or Medicaid, which cover all aspects of hospice care and services. There is no deductible for hospice services, although there may be a nominal co-payment for prescriptions and for respite care, a benefit offered to ease family caregiver burden. Hospice providers will accept private payment, referred to as “self-pay,” which may be an option for patients without healthcare insurance. Sometimes a patient who needs hospice care has no way to pay for it.

Fortunately, many hospice providers have a process for addressing the needs of people who are medically eligible for hospice but have neither insurance nor the financial resources to pay for end-of-life care. Military families have hospice coverage through Tricare. Veterans who are enrolled in the VA healthcare system and elect hospice care are covered through the VA system. Care is provided through the VA’s community partners; inpatient care may be offered at some VA facilities.

Fourth, hospice is not a place. Hospice is a philosophy of care. Most hospice is delivered in a home setting, which can be a private residence, nursing home, or other long-term care facility. Availability of residential hospice care, sometimes called a “hospice house,” is very limited for routine hospice care and requires additional private payment. Most in-patient hospice care is restricted to hospice patients whose symptoms cannot be managed in a home setting. In such cases, inpatient care is limited in duration and all costs are covered as part of the benefit package. The goal is to always return the patient to their home.

Fifth, we want people to know that hospice cares for family and friends who are caregivers or members of their intimate network. Respite care is available to unpaid caregivers, along with additional help from volunteers who can run errands, mow a lawn, or sit with a patient to give caregivers a break. In addition, hospices offer bereavement support for a year following a death to anyone needing help with grief. It’s the only part of our healthcare system that is required to provide grief support under federal law.

Many myths persist around hospice, despite decades of effort by organizations like Hospice Foundation of America (HFA), a 501(c)(3) nonprofit dedicated to teaching the public about hospice and teaching hospice professionals how to provide optimal care.

MHAOnline.com: Do you have any advice for those considering a career in hospice administration?

Tucci and Novas: While end-of-life care and management can be challenging, it affords a unique opportunity to make significant positive impacts on the lives of those we care for, and their family and caregivers. As hospice providers, every decision (whether clinical or administrative) has a direct impact on the quality of care being provided at the bedside for our patients in an environment where we only have one opportunity to get it right.

MHAOnline.com: What does the future of hospice care look like to you?

Tucci and Novas: While hospice care remains the gold standard for end-of-life care, providers can anticipate increased oversight focused on regulatory compliance and financial pressures. More hospice providers will also follow the existing trend to provide palliative care in their communities as a care option prior to hospice, easing the transition from aggressive treatment to hospice care.

Artificial intelligence (AI) will likely make a significant impact on hospice care, as it will on the entire healthcare sector. For hospice, AI has the potential to help physicians make earlier referrals to hospice; improve care plans, patient care, and regulatory compliance; and improve scheduling of staff amid workforce shortages. Finally, it is possible, but not probable, that the government at some future point may make hospice care less restrictive, enabling hospice patients to pursue treatment for their illness while receiving the benefits of hospice care.

While hospice care may be delivered in a patient’s residence, a nursing home, a residential care facility, or a hospital, most hospice programs are operated by independent agencies, with others affiliated with hospitals, nursing homes, or home health agencies. In every case, hospice administrators typically work from an office setting while coordinating care across these environments.

According to the National Hospice and Palliative Care Organization (NHPCO), the majority of hospice patients receive care at home. In 2022, 47.8 percent of Medicare hospice beneficiaries were cared for in a private residence, while others were served in nursing facilities (31.1 percent), assisted living facilities (10.6 percent), or inpatient hospice facilities and hospitals (10.4 percent).

Medicare, which covers nearly 90 percent of hospice patients, recognizes four levels of hospice care that determine both the care setting and reimbursement (CMS Medicare Benefit Policy Manual):

• Routine Home Care (RHC): The standard level of care, provided at home, in a nursing facility, or assisted living setting, during periods when the patient’s symptoms are managed.
• Continuous Home Care (CHC): Short-term crisis care in the home, requiring 8 to 24 hours of licensed nursing care in a day.
• Inpatient Respite Care (IRC): Up to five consecutive days of inpatient care to provide temporary relief for the patient’s caregiver.
• General Inpatient Care (GIP): Short-term inpatient care for pain control or other acute symptoms that cannot be managed in another setting.

While all four levels are defined in federal regulations, Routine Home Care accounts for nearly 99 percent of all hospice days. The other three levels are used only in limited circumstances (MedPAC, March 2024 Report to Congress).

A primary responsibility of a hospice administrator is to oversee the hospice’s staff and ensure that all services are delivered in compliance with Medicare’s Conditions of Participation. End-of-life care requires the coordination of multiple disciplines, and administrators foster collaboration across these specialties with the shared goal of providing comfort and dignity to patients and their families.

Federal regulations require every hospice program to have an interdisciplinary group (IDG) that includes at minimum a physician, registered nurse, social worker, and counselor (CMS, Medicare Benefit Policy Manual). In practice, hospice teams often extend beyond these core roles. According to the National Hospice and Palliative Care Organization (NHPCO), hospice teams may include:

• The patient’s attending physician and a hospice medical director
• Registered nurses and nurse practitioners
• Social workers
• Counselors (spiritual or bereavement)
• Home health aides
• Therapists (speech, physical, or occupational)
• Dietitians and pharmacists
• Trained volunteers

Grief and bereavement support are also essential components of hospice care. Under Medicare rules, hospices must offer bereavement services to family members for up to one year after a patient’s death. Hospice administrators play a key role in ensuring these programs are adequately staffed and responsive to the needs of surviving loved ones.

The role of a hospice administrator combines compassionate leadership with the operational demands of running a healthcare organization. Administrators must ensure that clinical staff can provide high-quality, patient-centered care while also maintaining financial stability, regulatory compliance, and organizational efficiency.

On a day-to-day basis, hospice administrators oversee both staff and systems. This includes financial management, strategic planning, and ensuring that adequate resources (such as medical supplies, durable medical equipment, contracted pharmacy services, and support staff) are available. Administrators also bear responsibility for ensuring compliance with federal, state, and local regulations, including Medicare’s Conditions of Participation, which govern hospice care delivery and reimbursement.

Some typical daily responsibilities of a hospice administrator include:

• Implementing and updating organizational policies and procedures
• Developing and monitoring budgets aligned with operational strategies
• Authorizing expenditures and overseeing vendor contracts
• Coordinating communication among patients, families, and staff
• Ensuring compliance with CMS and state hospice regulations and quality reporting requirements
• Overseeing procurement of medical supplies, equipment, and contracted services
• Assigning work schedules and supervising staff performance
• Recruiting, hiring, training, and, when necessary, disciplining or terminating staff

No two end-of-life scenarios are alike, and hospice administrators must balance their administrative obligations with the need to support patients and families with sensitivity. This requires both a solid educational background in healthcare management and the ability to foster collaboration, empathy, and resilience within the hospice team.

While it’s not a universal requirement, almost all hospice administrators will have at least a bachelor’s degree in an area like healthcare administration, business administration, or finance. And it’s becoming increasingly common for hospice administrators to pursue graduate education, such as a master of healthcare administration (MHA). At this stage, hospice administrators learn the intricacies of complex, industry-specific topics like healthcare finance, health law, health informatics, and marketing. It’s also possible to earn an MHA in a specialized concentration related to hospice care.

There are some skills a hospice administrator needs that can’t be taught in the classroom. Compassion is the most precious resource in hospice care, as dealing with end-of-life issues never gets easier—and if it does get easy, that can be a symptom of compassion fatigue.

Other skills, however, can be taught and learned over time; communication skills, for example, are at a premium in hospice administration. This role requires delicate conversations about serious issues and requires having those conversations with many people from different personal and professional backgrounds. Hospice administrators are responsible for running a business, but they can never lose sight of their product: providing compassionate care for those at their most fragile.

While hospices must be licensed in the states in which they operate, hospice administrators themselves are not required to hold state-level licensure. Voluntary professional certification, however, can strengthen a candidate’s qualifications and demonstrate commitment to excellence in hospice leadership.

The National Board for Home Care & Hospice Certification (NBHHC) is the primary body offering nationally recognized credentials in this field. NBHHC provides three tiers of certification for hospice administration:

• Certified Hospice Manager (CHM): For staff preparing for leadership or management roles in smaller agencies. Requires at least one year of hospice management experience.
• Certified Hospice Administrator (CHA): For experienced administrators, requiring one year in an administrator role or five years as a manager.
• Certified Hospice Executive (ACHE): For senior administrators at medium or large agencies, requiring at least three years of leadership experience.

A bachelor’s or master’s degree is preferred for all three certifications, although applicants with an associate’s degree or high school diploma may qualify with additional work experience. Candidates must pass a two-hour, 80- to 100-question exam.

To maintain certification, professionals must recertify every four years by documenting at least 12 months of relevant employment in the previous 48 months and completing 50 contact hours of professional development, split between continuing education and community support.