Why Pediatric Hospice is so F-ing Hard: 10 Reasons and 3 Ways Forward

Pediatric hospice care is one of the most emotionally demanding and complex fields in healthcare. It’s not just about managing symptoms—it’s about navigating impossible decisions, unexpected transitions, and systems that weren’t designed for children. As someone who has worked in this field, I know that reality is more complicated than it seems. Here are 10 reasons why pediatric hospice is so f-ing hard and a model for how we can start to make it better.

10 Reasons Why Pediatric Hospice is So F-ing Hard

1. Complex Cases Are Not Just Medical, They’re Human

Pediatric hospice isn’t just about making a child physically comfortable — it’s about navigating the delicate balance between comfort and hope. One day you’re managing pain, the next you’re helping a family prepare for an uncertain tomorrow. The real challenge isn’t the medicine; it’s the emotional duality that defines every decision.

2. The Hospital is a Revolving Door

Children in hospice care often transition back and forth between hospital and home, and each shift disrupts the fragile sense of stability. Just when it seems like the home care plan is taking shape, another hospitalization resets everything. It’s a constant wave that crashes against the idea of continuity. Hospice clinicians must surf the waves because families are facing an impossible choice to commit to one or the other, but it sure does make it complicated.

3. Dozens of Providers, One Patient

It’s not uncommon for pediatric patients to have a team of 20 specialists, each with their own unique lens on the plan of care. While everyone has the best intentions, coordinating among so many hands often leads to confusion and conflicting recommendations. It’s like trying to play a symphony when everyone is reading a different score.

4. The Traditional Hospice Model Wasn’t Made For This

The current hospice framework was never designed for children. Adult hospice models emphasize comfort, but pediatric care requires a more nuanced approach that blends curative efforts with palliative goals. It’s like trying to fit the ocean into a teacup—it spills over in every direction.

5. Unrealistic Expectations Turn Into Silent Regrets

Hospital teams often talk about the “ideal” of dying at home as if it’s a simple, peaceful transition. But the reality is far from easy, and families often find themselves unprepared for the physical and emotional demands of caregiving. When expectations aren’t met, families are left with regrets, wondering if they made the right choice.

6. Hospice Workflows Are Built for Simplicity, Not Complexity**

Hospice was built around routine workflows designed for predictability. But pediatric hospice is anything but predictable. Children’s needs change quickly, and the typical caseload expectations don’t account for the intensity of pediatric care. It often feels like playing a rigged game, where the rules were never made for you.

7. Complex Care Plans That Don’t Belong at Home

Doctors can design elaborate treatment plans, but translating those into a living room setting is another story. Families are often left to make impossible choices, deciding which parts of the care plan to keep and which to let go of. It’s not about their willingness; it’s about what’s realistically possible in the home.

8. The Burden of Caregiving on Families is Quietly Crushing

The strain on families goes beyond the emotional (which is huge). It’s financial, physical, and spiritual. Parents find themselves managing complex medical care while also trying to maintain some sense of normalcy. The cuts are small at first, but over time, they become deep scars—etched by exhaustion and grief.

9. The Line Between Benefit and Burden is Blurred

Families are forced to constantly evaluate whether each intervention is truly helpful or simply adding to the burden of care. Seizure meds, transfusions, or chemotherapy—they’re choices, not mandates. And each decision weighs heavier than the last, as families try to do what’s right without clear answers.

10. The System Wasn’t Built for Change, But We Are

Pediatric hospice exists within a system that wasn’t designed for it. The funding models, staffing, and protocols are all designed for a different kind of care. But the people who show up every day for this work are driven by a different truth: that, slowly, we can change the system, even if only through the persistence of our presence.

The Three-P Model for Making Pediatric Hospice Better

While pediatric hospice may seem impossible to fix, there are three levels where change can happen:

1. Policy
   Push for progress at the state and national levels by advocating for broader eligibility criteria, increased reimbursement rates, and dedicated funding for pediatric hospice care.
2. Procedure
   Prioritize the process within agencies by accepting financial realities while striving for creative funding solutions, investing in talent development, and building strong networks of support. Remember, the pediatric service line doesn’t have to be a financial loss; keep evaluating the business case to optimize where possible.
3. Perspective
   Protect your perspective by cultivating a mindset focused on teamwork, empathy, and sustainable self-care. It’s not about being the hero; it’s about showing up with compassion, day after day.

Final Thoughts

Pediatric hospice care is hard—there’s no sugarcoating it. But by focusing on what’s possible at the policy, procedure, and perspective levels, we can start to make a real difference. It’s not about finding a perfect solution; it’s about taking imperfect, meaningful steps forward, one at a time.

Want to Approach Hospice Conversations with More Confidence and Compassion?
Download our free guide, "The Compassionate Communicator: A Guide to Talking About Pediatric Hospice," and get practical tips, scripts, and mindset shifts to help you have clear, empathetic discussions with families. Whether you're new to pediatric hospice or a seasoned professional, this guide offers insights to support you and those you serve.

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