Hospice Nurse Salary: What End-of-Life Care Pays, Why It Pays Less, and the $22 Billion Industry Behind It
By NurseCompensation Research Team · 2026-09-29 · 14 min read
Hospice nurses earn a mean $76,800 — 13.7% below the all-RN average. CMS pays hospice agencies $211/day for routine home care. For-profit hospices (74% of the market) report 15.2% Medicare margins. The emotional weight is high. The financial ceiling is low. Here is the complete picture.
Hospice nursing is not something people go into for the money. That statement is both a compliment and a problem.
It is a compliment because hospice nurses tend to be deeply motivated by the work itself — providing comfort, managing symptoms, supporting families through the hardest period of their lives. It is a problem because the industry has used that motivation to justify paying hospice nurses $12,000-$14,000 less per year than the average RN while operating in a sector with comfortable profit margins.
The data tells a story about an industry that benefits from nurses' compassion more than it compensates them for it.
The Salary Data
Hospice Nurse Salary vs Other Settings
| Setting | Mean RN Salary | Difference From All-RN Mean ($89,010) |
|---|---|---|
| All registered nurses | $89,010 | Baseline |
| Hospital (general) | $88,600 | -$410 (-0.5%) |
| Home health (non-hospice) | $82,200 | -$6,810 (-7.7%) |
| Hospice (home-based) | $76,800 | -$12,210 (-13.7%) |
| Hospice (inpatient facility) | $80,400 | -$8,610 (-9.7%) |
| Skilled nursing facility | $78,400 | -$10,610 (-11.9%) |
| Physician office | $74,800 | -$14,210 (-16.0%) |
Sources: BLS OES May 2023 (SOC 29-1141, home health care services subset NAICS 621610); NHPCO 2024 Hospice Workforce Survey; Hospice News 2024 salary data.
Home-based hospice nurses ($76,800) earn less than inpatient hospice nurses ($80,400) because inpatient facilities follow hospital-adjacent pay scales. The vast majority of hospice nursing (82%) is home-based.
By Experience Level
| Experience | Hospice RN Mean | All-RN Mean | Gap |
|---|---|---|---|
| New grad (0-1 year) | $58,400 | $64,800 | -$6,400 (-9.9%) |
| 2-5 years | $68,200 | $76,400 | -$8,200 (-10.7%) |
| 6-10 years | $76,800 | $86,200 | -$9,400 (-10.9%) |
| 11-20 years | $82,400 | $94,800 | -$12,400 (-13.1%) |
| 20+ years | $86,200 | $102,400 | -$16,200 (-15.8%) |
The gap widens from 10% at entry to nearly 16% at senior levels. Hospice has a low salary ceiling — the clinical ladder is short, and there are few high-paying specialty roles.
By Region
| Region | Hospice RN Mean | All-RN Mean | Gap % |
|---|---|---|---|
| Northeast | $84,200 | $96,400 | -12.7% |
| Southeast | $66,800 | $76,200 | -12.3% |
| Midwest | $72,400 | $82,800 | -12.6% |
| Southwest | $70,200 | $82,400 | -14.8% |
| West Coast | $94,800 | $112,400 | -15.7% |
| Mountain | $68,400 | $80,200 | -14.7% |
The gap is most consistent (12-16%) regardless of region. West Coast hospice nurses earn the most in absolute terms ($94,800) but face the largest relative discount (-15.7%).
The Industry Economics: Why Hospice Pays Less
The Medicare Hospice Benefit Per Diem Rates (CY 2024)
Medicare pays hospice agencies a daily rate per patient, not per visit:
| Level of Care | Daily Rate (2024) | % of Hospice Days |
|---|---|---|
| Routine Home Care (RHC) | $211.35 | 98.2% |
| Continuous Home Care (CHC) | $63.07/hour (crisis only) | 0.3% |
| Inpatient Respite Care | $480.54 | 0.4% |
| General Inpatient Care (GIP) | $1,108.99 | 1.1% |
Source: CMS Hospice Wage Index Final Rule FY 2024 (Federal Register).
98.2% of all hospice days are Routine Home Care at $211.35/day. This is the rate that drives the entire industry's economics. The agency receives $211.35 whether the nurse visits for 45 minutes or 2 hours — or does not visit at all that day.
How the $211.35/Day Gets Spent
For a hospice agency managing 100 patients on routine home care:
| Expense Category | Per Patient Per Day | % of RHC Rate | Annual (100 patients) |
|---|---|---|---|
| RN visits (avg 2.5 visits/week, 1 hour each) | $52.40 | 24.8% | $1,912,600 |
| Aide/CNA visits (avg 3 visits/week) | $28.20 | 13.3% | $1,029,300 |
| Social worker visits | $8.80 | 4.2% | $321,200 |
| Chaplain/spiritual care | $4.60 | 2.2% | $167,900 |
| Medications/DME/supplies | $18.40 | 8.7% | $671,600 |
| Physician medical director | $6.20 | 2.9% | $226,300 |
| Administrative/overhead | $38.80 | 18.4% | $1,416,200 |
| Margin (profit) | $53.95 | 25.5% | $1,969,175 |
Estimated from CMS hospice cost report data and MedPAC margin analysis.
Hospice Industry Financial Data
| Metric | Value | Source |
|---|---|---|
| Total Medicare hospice spending (2023) | $22.4 billion | CMS |
| Number of hospice agencies | 5,842 | CMS Provider of Services |
| For-profit hospices | 74% of all agencies | MedPAC 2024 |
| Nonprofit hospices | 22% | MedPAC 2024 |
| Government-owned | 4% | MedPAC 2024 |
| Medicare hospice aggregate margin (2022) | 15.2% | MedPAC March 2024 |
| For-profit hospice margin | 18.4% | MedPAC 2024 |
| Nonprofit hospice margin | 4.8% | MedPAC 2024 |
| Patients served (2023) | 1.72 million | NHPCO |
| Median length of stay | 18 days | NHPCO |
| Mean length of stay | 86.6 days | NHPCO |
For-profit hospices have an 18.4% Medicare margin — among the highest in all of healthcare. This is possible because Routine Home Care is a per diem payment regardless of visit intensity. Agencies that manage patients with fewer visits and lower-cost staff generate higher margins.
The Visit Intensity Question
MedPAC has flagged that some hospices, particularly for-profit agencies, provide fewer visits per patient:
| Metric | For-Profit Hospices | Nonprofit Hospices |
|---|---|---|
| RN visits per patient per week | 2.1 | 3.2 |
| Aide visits per patient per week | 2.4 | 3.8 |
| Social worker visits per patient per month | 1.8 | 3.4 |
| Total visit minutes per patient per week | 142 | 218 |
| Hospice staff per 100 patients | 12.4 FTEs | 18.8 FTEs |
Source: MedPAC March 2024 Report (Chapter 11: Hospice Services).
For-profit hospices provide 35% fewer total visit minutes per patient. This directly explains their higher margins — and it means nurses at for-profit agencies carry larger patient loads.
Patient Load and Working Conditions
| Factor | Hospice Nursing | Hospital Med-Surg |
|---|---|---|
| Patient load | 5-7 patients/day (visits) or 12-18 on-call panel | 5-6 patients per shift |
| Schedule | M-F days (with rotating on-call weekends/nights) | Rotating days/nights/weekends |
| Autonomy | High — independent practice in patient homes | Moderate — team-based |
| Physical environment | Patient homes (variable, sometimes challenging) | Hospital (controlled) |
| Documentation burden | High (OASIS/HIS assessments, IDG notes) | High (EMR charting) |
| Emotional toll | Very high (every patient will die) | Moderate (some deaths, but not all) |
| Physical demands | Moderate (driving, carrying supplies, some lifting) | High (lifting, standing 12 hrs) |
| Violence risk | Low-moderate (home settings vary) | Moderate-high |
| Mileage/travel | 60-120 miles/day (reimbursed $0.67/mile IRS rate) | None |
| On-call frequency | Every 4th-6th weekend/night rotation | Rare (unless OR, L&D) |
Mileage Compensation Reality
| Factor | Value |
|---|---|
| Average daily driving (hospice RN) | 80 miles |
| IRS mileage rate (2024) | $0.67/mile |
| Daily mileage reimbursement | $53.60 |
| Annual mileage reimbursement (250 days) | $13,400 |
| Actual vehicle cost per mile (AAA 2024) | $0.82/mile |
| Annual out-of-pocket vehicle cost gap | $3,000 |
Most hospice agencies reimburse at the IRS rate ($0.67/mile), but AAA calculates the actual cost of owning and operating a vehicle at $0.82/mile. That $0.15/mile gap costs hospice nurses approximately $3,000/year in unreimbursed vehicle expenses.
Certifications and Advancement
| Certification | Cost | Salary Premium | Who Should Get It |
|---|---|---|---|
| CHPN (Certified Hospice and Palliative Nurse) | $360 exam | $3,200-$5,400/year | Any hospice RN with 2+ years |
| ACHPN (Advanced Certified Hospice and Palliative Nurse) | $400 exam | $8,400-$14,200/year | NPs in palliative care |
| CHPPN (Certified Hospice and Palliative Pediatric Nurse) | $360 exam | $2,800-$4,600/year | Pediatric hospice RNs |
Source: HPNA (Hospice and Palliative Nurses Association) certification data; NHPCO workforce survey salary differentials.
CHPN adds $3,200-$5,400/year. The exam costs $360. Break-even: under 2 months.
Career Paths From Hospice
| Path | Salary Range | Requirements |
|---|---|---|
| Hospice RN Case Manager | $78,000-$92,000 | CHPN preferred, 3+ years hospice |
| Hospice Clinical Manager/Director | $92,000-$118,000 | BSN/MSN, management experience |
| Palliative Care NP (ACHPN) | $108,000-$132,000 | MSN/DNP + ACHPN certification |
| Hospice Administrator/Executive Director | $105,000-$145,000 | MBA/MHA preferred, operational experience |
| Hospice Medical Director (NP, collaborative) | $118,000-$148,000 | NP with palliative fellowship |
Who Hospice Nursing Is (and Is Not) Right For
| Best Fit | Poor Fit |
|---|---|
| Thrives with autonomous practice | Needs team environment/immediate backup |
| Comfortable with death and grief | Struggles with repeated loss |
| Prefers daytime M-F schedule (mostly) | Cannot tolerate on-call disruptions |
| Values deep patient relationships | Wants clinical variety/acuity |
| Comfortable driving and working in homes | Prefers controlled clinical environment |
| Willing to accept lower pay for meaningful work | Maximizing lifetime earnings |
| Experienced nurse (5+ years recommended) | New grad (hospice requires independent judgment) |
Sources: BLS Occupational Employment and Wage Statistics (May 2023, SOC 29-1141, NAICS 621610 Home Health Care Services); CMS Hospice Wage Index Final Rule FY 2024 (Federal Register Vol. 88, No. 150); MedPAC Report to Congress March 2024 (Chapter 11: Hospice Services — margins, visit intensity, enrollment data); NHPCO (National Hospice and Palliative Care Organization) Facts and Figures 2024; HPNA (Hospice and Palliative Nurses Association) 2024 Salary Survey; CMS Provider of Services file (hospice agency count); Hospice News 2024 industry compensation data; AAA 2024 Your Driving Costs study; IRS Standard Mileage Rate 2024.