Central Texas Loses Its Only Pediatric In-Home Hospice Service

Dell Children's Medical Center in Austin is closing its Hospice at Home program on Friday. The service operated for four years and was the only provider in Central Texas offering pediatric hospice care in a child's residence. The hospital will shift these services to an outpatient clinic setting.

In a statement, Dell Children's said the program is transitioning to the Comprehensive Care Clinic. This clinic specializes in complex diagnoses and already handles hospice and palliative care referrals. The hospital stated that individualized transition plans exist for every patient to ensure continuous care.

Shannon McLennan, a Leander mother and former Dell Children's nurse, learned of the closure two weeks ago. Her 19-year-old daughter, Oli, has suffered from intestinal failure and a genetic condition affecting her vision since March. McLennan said she did not receive a transition plan and was informed the change was tied to Medicaid certification issues. Texas law requires hospice agencies to be licensed Home and Community Support Services Agencies and hold specific Medicaid contracts for reimbursement.

McLennan argued that expecting parents to transport dying children to a clinic is unrealistic. She noted that she cannot currently get her daughter into a car. Many parents are uncomfortable administering morphine for pain control or understanding the dying process, which is why in-home support is often preferred over hospital or clinic settings.

The program launched in 2022 after neonatologist Dr. Patrick Jones joined Dell Children's. He previously established a similar system in Houston. Jones left the hospital in March to work for a neonatology group covering Ascension Texas facilities. Dr. Tyler Badding subsequently took over the hospice and palliative care role, though the hospital has since removed its hospice page from its website.

National data supports the difficulties of maintaining such programs. A 2025 report by the National Alliance for Care at Home identified staffing as the primary barrier to pediatric hospice. The report found a shortage of trained doctors and nurses and noted that insufficient referrals from physicians contribute to the problem. Cost and reimbursement rates played a larger role in the 2025 findings compared to previous years.

Pediatric hospice care is not mandated for insurance coverage. According to the alliance, 60.1% of children needing this care rely on Medicaid, which typically pays lower per diem rates than private insurance or Medicare. Hospice Austin, a nonprofit partner, does not currently have a pediatrician on staff. It stated it is discussing ways to support community needs. Texas Children's Hospital and St. David's Children's Hospital in Austin also lack hospice programs.

The Abigail E. Keller Foundation is raising $6 million for Abbey House, which would be Texas' first dedicated pediatric palliative care and hospice center. The facility aims to provide a home-like environment for end-of-life care. Melissa Keller, Abbey's mother, noted that her daughter was among the last children to benefit from the previous shared arrangement between Dell Children's and Hospice Austin. She said her family valued the continuity of that partnership.