Four years after launch, Dell Children's closes its only in-home pediatric hospice

Dell Children's Medical Center will shut down its Hospice at Home program this Friday, ending the only service in Central Texas that brought palliative and hospice care directly to the homes of dying children. The closure eliminates a model that allowed families to keep their sick children in familiar surroundings rather than transporting them to a clinic for medical attention.

The hospital announced the change in a statement, describing the move as a transition from home-based care to an outpatient clinic setting. The Comprehensive Care Clinic, which treats children with complex diagnoses, will absorb the caseload. Dell Children's noted that referrals for these complex care services are already processing and that individualized transition plans have been drafted for each child currently enrolled in the program.

Shannon McLennan of Leander learned of the closure two weeks ago. Her daughter, Oli, has a genetic deletion affecting her vision and suffers from intestinal failure. Oli has received care from the program since March. McLennan stated she was not provided with a specific transition plan for her daughter. She was told the decision stemmed from the hospital's Medicaid certification for hospice reimbursement.

In Texas, hospice agencies must hold a license as a Home and Community Support Services Agency and maintain a contract for Medicaid hospice services. Because Oli is 19, she is eligible to transfer to Hospice Austin, which operates an adult program but no longer staffs a pediatric unit. McLennan, a nurse who previously worked at Dell Children's, argued that expecting parents to transport dying children to a clinic is unrealistic. She said she cannot even get her daughter into a car.

McLennan posted her frustration on Instagram, noting that the pediatric population in Austin and surrounding areas lacks an in-home option. "They're not going to be at home, if that's what they choose," she wrote. "Now they have no choice. Our kids that have cancer, who have spent way more than I can ever imagine being in a hospital, will have to die in a hospital."

Dell Children's has not publicly explained the specific reasons for the closure despite inquiries regarding staffing, certification, or funding. The program launched in 2022 after neonatologist Dr. Patrick Jones arrived from Memorial Hermann Health System in Houston, where he had established a similar pediatric hospice system. Dr. Jones left Dell Children's in March to work for a neonatology group serving Ascension Texas hospitals. Dr. Tyler Badding assumed the hospice and palliative care role but is now listed in the hospital's palliative care program, and the hospital has removed its dedicated hospice webpage.

A 2025 report from the National Alliance for Care at Home identified staffing as the primary barrier to pediatric hospice care. The U.S. faces a shortage of pediatric doctors and nurses trained in this field, and insufficient referrals from physicians compound the issue. Costs and reimbursements became a larger factor in 2025 compared to previous years. Because pediatric hospice and palliative care are not mandated by insurance, 60.1% of children needing these services rely on Medicaid, which typically offers lower reimbursement rates than private insurers or Medicare.

Hospice Austin, a nonprofit that previously partnered with Dell Children's, stated it is discussing how to support the community's need for additional pediatric hospice services. The organization does not currently have a pediatrician on staff. Texas Children's Hospital and St. David's Children's Hospital, both operating in Austin, also lack hospice programs.

The Abigail E. Keller Foundation is raising $6 million to build Texas' first pediatric palliative care, hospice, and respite center, called Abbey House. The facility aims to provide a home-like setting for care. Melissa Keller, whose daughter Abbey died in 2019 at age 11, said the foundation is beginning to offer social workers to families. She noted that low reimbursement rates make the project reliant on philanthropy. "We never wanted Abbey to die in the hospital," she said. "That’s the last place you want them to pass."