Hospice at home vs private end-of-life care

Hospice at home in London is free specialist care from a local hospice or Marie Curie, focused on symptom control, nursing and emotional support for someone who is dying. Private end-of-life care is paid-for help from a home care agency, usually covering personal care, company and overnight support for as many hours as you need. Most families get the best result by using both: the hospice for clinical expertise, and paid or NHS-funded carers for the hours in between.

Live in West Sussex? Read our local guide: End of life care at home Worthing guide: hospice support, funding and what to expect.

At a glance

• Hospice care is free for patients, carers and families (Hospice UK), funded by the NHS and public donations.
• Hospice at home is usually referred by a GP, district nurse or hospital team, and places can be limited.
• Private live-in end-of-life care in London typically costs £1,500–£2,500+ a week as of 2026. Sources vary; always get a written quote.
• Fast Track NHS Continuing Healthcare can pay for carers at home for someone rapidly deteriorating.
• Marie Curie’s free Support Line: 0800 090 2309.

What is hospice at home?

NHS.uk describes hospice care as “a style of care, rather than something that takes place in a specific building”. Hospice at home brings that care into the person’s own home. Depending on the local service, it may include:

• specialist palliative nurses and doctors who advise on pain and symptoms;
• hands-on nursing and personal care, sometimes overnight;
• rapid response visits when symptoms flare;
• emotional, spiritual and practical support for the whole family;
• bereavement support after death.

Hospice teams work alongside the GP and district nurses rather than replacing them. Hospice UK says hospice care is not only for people with cancer. It also supports people with dementia, heart, lung, liver and kidney failure, motor neurone disease and frailty.

Who provides hospice at home in London?

London is covered by a network of local hospices, each serving particular boroughs. Examples include:

• St Christopher’s Hospice, Sydenham, which provides community care in people’s homes across south-east London, including Lewisham (Lewisham Council).
• St Joseph’s Hospice, Hackney, whose specialist nurses, doctors and social workers support people at home in areas including Tower Hamlets (Tower Hamlets Council).
• Marie Curie, which runs hospice care at home in most London boroughs, with urgent round-the-clock services in Ealing and Hounslow, Newham and City and Hackney, Bromley and Lewisham, and Greenwich, and an enhanced service in Camden and Islington (Marie Curie, September 2026).

Find your local service using the Hospice UK Hospice Care Finder, or ask the GP.

What is private end-of-life care at home?

Private end-of-life care is provided by a home care agency registered with the Care Quality Commission (CQC). Carers help with:

• washing, dressing, mouth care and continence care;
• repositioning to protect skin, following the nurses’ plan;
• helping with food and drink as appetite changes;
• medication support as set out in the care plan;
• company, reassurance and being there overnight so family can rest.

Care can be visiting (from an hour or two a day), live-in, or waking nights. Some agencies offer nurse-led care for more complex needs. Agency carers do not replace district nurses, who still manage clinical tasks like syringe drivers.

Hospice at home vs private care: side by side

Private price ranges: The Care Panel analysis of 2026 provider and marketplace prices, including Helping Hands (April 2026) and Country Cousins (May 2026). Sources vary, so always get a written quote showing night, weekend and bank-holiday rates.

Which should you choose?

It is rarely a straight choice. Think about what the person needs day to day. Our palliative care hub sets out every option.

Hospice at home may be enough if:

• a family member lives with the person and can provide most care;
• needs are mainly about symptom control and nursing advice;
• the local hospice can offer the level of visits needed.

Adding paid carers helps if:

• the person lives alone or with a frail partner;
• family carers are exhausted or work full-time;
• the person needs help at night, or two carers for moving;
• the hospice has a waiting list or limited hours.

Many families start with visiting care and move to live-in or waking nights in the final weeks. Our guide to waking nights and sleep-in carers explains the difference.

Can the NHS pay for the private carers?

Often, yes. If someone has a rapidly deteriorating condition and may be entering a terminal phase, a doctor or nurse can complete the Fast Track Pathway Tool for NHS Continuing Healthcare. The ICB then funds a care package at home, which is not means-tested. Marie Curie says care should usually be in place within two working days, though it can take longer in some areas.

CHC-eligible adults have a legal right to a personal health budget, which can give you more say over the agency used. Read our full guide to Fast Track Continuing Healthcare.

If CHC is not awarded, the council can assess needs under the Care Act. Council-funded care is means-tested, with an upper capital limit of £23,250 in England (DHSC, 2026/27).

Questions to ask a private provider

• Are you CQC-registered, and what is your current rating?
• Have your carers had end-of-life care training?
• How do you work with district nurses and the hospice team?
• How quickly can you increase hours if needs change?
• Can you provide waking nights at short notice?
• What happens if the regular carer is off sick?
• Do you accept Fast Track CHC or personal health budget funding?

Our guide on choosing a home care agency in London has a fuller checklist, and our palliative care cost guide covers pricing in detail.

Frequently asked questions

Is hospice at home free in London?

Yes. Hospice care, including hospice at home, is free for patients, carers and families. NHS.uk says it is funded by a mix of NHS money and public donations. Places are limited, so the level of support varies by area. Ask the GP or district nurse for a referral, or check the Hospice UK Hospice Care Finder.

How do I get a referral to hospice at home?

Hospice UK says the GP or hospital doctor usually makes the referral, and district nurses can refer too. Some hospices accept self-referrals and then contact the person’s doctor. If your relative is in hospital, ask the ward or palliative care team to refer before discharge.

Can hospice at home and private carers work together?

Yes, and this is common. The hospice team focuses on symptom control, nursing and family support. Private or NHS-funded carers cover personal care and longer hours, including nights. Make sure everyone shares the same care plan and knows who to call if symptoms change.

How much does private end-of-life care cost in London?

As of 2026, visiting care in London is typically £30 to £40 an hour, and live-in end-of-life care about £1,500 to £2,500 or more a week. Waking nights are usually £240 to £320 a night. Sources vary, so always ask for a written quote. Fast Track CHC may cover the cost.

Does hospice care only help people with cancer?

No. Hospice UK says hospices support people with many life-limiting conditions, including dementia, heart failure, COPD, kidney or liver failure, motor neurone disease and frailty. If your relative has any terminal illness and complex symptoms, ask their GP about a hospice referral.

Sources

• NHS.uk: Hospice care
• NHS.uk: End of life care at home
• Hospice UK: What is hospice care?
• Hospice UK: Hospice Care Finder
• Marie Curie: Our services in London
• Marie Curie: NHS continuing healthcare
• Marie Curie: Support Line
• Lewisham Council: End of life care
• Tower Hamlets Council: Hospice services
• DHSC: Social care charging 2026 to 2027
• Helping Hands: Cost of palliative care
• Country Cousins: Palliative care at home cost in the UK

This guide is general information, not financial, legal or medical advice. Last reviewed September 2026.

Reviewed by The Care Panel team on 15 October 2026. This guide is general information about care in England, not legal, medical or financial advice. Rules and rates change; check with your council or an adviser before making decisions.