Medicare Hospice Grief Support Lasts a Year. Then What?
Quick Answer
Under the federal hospice rule at 42 CFR 418.64, hospices must make bereavement support available to families for up to 1 year after the death, and the rule leaves the kind and frequency of that support to each hospice. Grief often continues into the second year, after that support has ended. For adults, grief that stays intense and disrupts daily life 12 months or more after a death can be diagnosed as prolonged grief disorder (American Psychiatric Association, DSM-5-TR). A licensed professional counselor who works with grief, a community grief group, or both can carry support past that window, including after a stillbirth or infant loss.
The hospice nurse stops visiting. The bereavement coordinator sends a final card, often near the first anniversary of the death. Grief does not end on that date.
The gap comes from how hospice bereavement programs are set up: the federal rule requires support for up to a year after the death. Before the hospice's grief support ends, you can ask its bereavement team what it offers your family and when it will stop, so you can plan what comes next. Bereavement services are the grief support a hospice offers the family after a death, and they can range from a few phone calls and mailings to support groups and individual counseling.
Grief often continues into the second year, after the cards and calls have stopped. When it stays intense and keeps disrupting daily life for 12 months or more, the American Psychiatric Association recognizes it as prolonged grief disorder, and evidence-based treatment is available.
Not every loss comes through hospice. If you are searching for grief counseling after a stillbirth or infant loss near Frisco or Dallas, much of what follows about timing and choosing the right counselor applies to you, too.
Where can you find grief counseling near you when hospice support ends?
Grief counseling near you can come from hospice groups, community groups or a licensed therapist.
When people type "grief counseling near me" into a search bar, they are often many months past the funeral. The hospice team has stopped calling. Friends and coworkers have gone back to their routines, while the person searching still wakes up tired and heavy with a loss that does not feel finished. As a licensed professional counselor-supervisor and certified school counselor, I see this later stretch as the part of grief that formal programs plan for least.
Start with what is closest. Bereavement is the period of mourning that follows a death, and some hospices offer bereavement counseling of their own, from support groups to one-on-one sessions. It is worth asking your own hospice what it offers before its support period closes.
Grief also shows up in the body. Tightness in the chest or throat, trouble sleeping, fatigue that does not improve with rest, brain fog and panic can all be part of it. Depending on your needs, our grief therapy can include somatic and nervous system-based approaches, so physical signs like these are worth mentioning in a first session.
What does Medicare hospice grief support actually include?
Medicare requires hospices to make bereavement support available to families for up to 1 year after a death (42 CFR 418.64). Hospice providers such as Lifted Hospice and Graceland Hospice Care describe it as at least 13 months, at no cost to the family.
If your hospice is still in touch, a few questions can show you what is really on offer:
- Which services can I use: phone check-ins, one-on-one counseling, support groups, or referrals?
- Who will contact me, and how often?
- What happens when your bereavement program ends?
- Can you refer me to a licensed therapist now, while the program is still open?
The Medicare hospice benefit was established in 1983 to provide palliative care and support services to terminally ill people and their families, according to a 2015 issue brief from the HHS Office of the Assistant Secretary for Planning and Evaluation (ASPE). In 2015, the same brief reported that hospice was used by nearly half of all Medicare beneficiaries who die in a year, after that share more than doubled over 15 years, from 22% to 46%. Because the benefit was written to include families, bereavement support has been part of it from the start.
Under the CMS hospice Conditions of Participation, the federal rules hospices follow under Medicare, bereavement services must be available for up to 1 year after the death. The hospice must also assess your family's grief needs while your loved one is still in care and write a bereavement plan. The support can include counseling, support groups, regular check-ins and referrals.
The rule speaks to availability. It does not spell out how personal or how frequent the support must be. Medicare's own hospice coverage page lists "spiritual and grief counseling for you and your family" among hospice services, without saying how much.
Your family is guaranteed access to some bereavement support for up to a year, but how much support each hospice offers can vary a great deal. If you are unsure what your family's bereavement plan includes, you can ask the hospice to walk you through it. If the support offered feels lighter than you need, it is reasonable to look for more help now rather than waiting for the program to end.
The program ends on a schedule, whether or not your grief has eased. If you would like your support to continue without a break, you can begin looking for a therapist while the hospice program is still open. Our therapists take most major insurances, but your independent benefits determine your specific payment per session, and you can call us at 469-238-2686 to learn about your plan. If you want a sense of what that next stage can look like, our page on grief therapy in Frisco describes how we work with loss.
It may help to mark on your calendar the date your hospice's bereavement program will end, so that day does not catch you by surprise. For many families it ends around the first anniversary of the death.
How much grief support does a hospice actually owe your family?
When someone you love dies in hospice care, the promise of a year of grief support can be a real comfort. The federal rule behind that promise is shorter and less specific than many hospice descriptions suggest.
Lifted Hospice and Graceland Hospice Care, two hospice providers, both say Medicare requires bereavement support for "at least 13 months." The regulation reads differently. Under 42 CFR 418.64(d)(1), a hospice must make bereavement services available to the family "up to 1 year following the death of the patient." The regulation text never mentions 13 months, and none of our sources explains where that figure comes from. Either way, the window lasts about a year.
The rule also leaves a great deal open. The same section requires an organized grief program supervised by a qualified grief professional, with services that "reflect the needs of the bereaved." Under 42 CFR 418.54(c)(7), the hospice also assesses the family's grief needs while the patient is still in care, looking at "social, spiritual, and cultural factors" that may affect coping. It then writes a bereavement plan noting "the kind of bereavement services to be offered and the frequency of service delivery" (42 CFR 418.64). The rule never says what that kind or frequency must be.
| The federal rule requires | The rule leaves to each hospice |
|---|---|
| Grief services made available up to 1 year after the death | How many calls, visits or sessions a family receives |
| An organized program supervised by a qualified grief professional | Whether one-on-one counseling or home visits are offered |
| An assessment of the family's grief needs before the death | The format: mail, phone, groups, visits or video |
| A written plan naming the kind and frequency of services | Any support after the first year |
Maxwell TEC, which sells hospices a text-message alternative to bereavement mail, writes that the industry has traditionally sent "paper bereavement letters or postcards," a process that does not let families "request additional help." The company has a product to sell, but its description shows how one-way that outreach can be.
Lifted Hospice describes phone check-ins, one-on-one grief counseling and support groups, and it refers families to licensed therapists "when grief becomes complicated or prolonged." Graceland lists risk factors for complicated grief, including a history of depression, social isolation and earlier losses. It says sudden deaths, deaths involving prolonged suffering and difficult family dynamics "raise the risk level considerably." In both accounts, the heaviest grief goes to outside therapists.
The hospice grief calendar
- Before the death: the hospice assesses the family's grief needs (42 CFR 418.54).
- First month, three months, six months: mailed grief materials in Lifted Hospice's program.
- One year: Lifted's last milestone mailing, and the end of the "up to 1 year" in the federal rule.
- After the first anniversary: the rule text requires no further hospice support.
Grief does not always follow that calendar. For adults, the American Psychiatric Association's diagnosis of prolonged grief disorder applies only once 12 months have passed since the death (APA, DSM-5-TR), so the hospice's obligation ends at the point where that diagnosis first becomes possible.
Every hospice must offer a year of support and plan it around your family's needs, with no required minimum. How much help arrives depends on the hospice, and the calendar ends whether or not grief has eased. Graceland Hospice Care's own checklist advises, "Do not wait until after the death to find out what your hospice provides."
- While your loved one is still in hospice care, ask the social worker or bereavement coordinator what your family's bereavement plan lists: which services, and how often.
- Ask whether the hospice offers one-on-one grief counseling or home visits, or mainly mailings and phone calls, and whether its support groups are open to you.
- If the death was sudden or followed prolonged suffering, or if earlier losses, depression, isolation or hard family dynamics are part of your story, ask early how the hospice refers families to licensed therapists.
- Ask when the hospice's last scheduled contact will be, so you know ahead of time when its support ends relative to the first anniversary.
How we checked this
We read the federal hospice regulations directly, two hospice providers' descriptions of their own grief programs, a hospice software vendor's blog and the American Psychiatric Association's guidance on prolonged grief disorder. No figures in this section come from our own practice. We left out a widely shared survey of hospice grief services because its source could not be traced. The hospice providers describe their own services, Maxwell TEC sells bereavement software to hospices, and we are a counseling practice that offers grief therapy, so each of us has a stake. Still unknown: where the widely repeated 13-month figure comes from, and how many families go on to seek therapy after hospice support ends.
- Electronic Code of Federal Regulations, 42 CFR 418.64 hospice core services, retrieved October 20, 2026.
- Electronic Code of Federal Regulations, 42 CFR 418.54 hospice assessment rules, retrieved October 20, 2026.
- Graceland Hospice Care, bereavement support checklist for hospice families, May 14, 2026.
- Lifted Hospice, glossary entry on hospice bereavement support, February 28, 2026.
- Maxwell TEC, blog post on hospice bereavement regulations, February 5, 2025.
- American Psychiatric Association, prolonged grief disorder, physician review August 2025, retrieved October 27, 2026.
What happens to grief in the second year?
For most people, grief symptoms ease over time. The American Psychiatric Association (APA) notes that grief can still rise again at different points, and that these ups and downs usually do not call for mental health treatment. Grief that is still active in the second year is common, and on its own it is not a sign that something is wrong.
What changes in the second year is the support around you. The hospice's bereavement program has closed, for many families around the first anniversary. Cards, bereavement leave and check-ins tend to come in the days after a death and fade over the following months, as our article on grief after the funeral describes. Anniversaries, holidays, birthdays and other milestones can bring grief back, even years later.
Some people describe the second year this way. Mary Roblyn, a writer whose husband died in April 2023, opened a Substack essay about her second year as a widow with a line she credits to "every widow I know": "The second year is harder than the first." Two years after his death, she wrote, "The world has moved on." Her essay is one person's account. It shows what the second year can feel like from the inside, and it cannot tell us how many people find the second year harder.
Prolonged grief disorder is the clinical name for grief that stays intense and keeps disrupting daily life. The APA added it to the DSM-5-TR, its diagnostic manual, in March 2022. For adults, the death must have happened at least 12 months earlier (at least 6 months for children and adolescents), and the person must have had at least 3 of these symptoms nearly every day for at least the past month:
- Identity disruption, such as feeling that part of yourself has died
- A marked sense of disbelief about the death
- Avoiding reminders that the person is dead
- Intense emotional pain, such as anger, bitterness or sorrow, related to the death
- Trouble reengaging with friends, interests or plans for the future
- Emotional numbness
- Feeling that life is meaningless without the person who died
- Intense loneliness, or feeling detached from others
The grief must also last longer than social, cultural or religious norms would lead others to expect, and it must cause real distress or problems at home, at work or in family life. The APA estimates that 4% to 15% of bereaved adults develop these persistent symptoms. For adults, the 12-month threshold falls at the same point the federal rule lets hospice bereavement support end.
Several risk factors on the APA's list can apply to hospice families: high levels of grief before the death, a history of depression, being very close to or emotionally dependent on the person who died, the death of a spouse, partner or child, and a lack of social support. If any of these are part of your story, they are worth raising with a therapist, whether or not your grief meets that definition.
Sleep can need attention of its own. The APA notes that sleep problems can occur along with prolonged grief, and that cognitive behavioral therapy for insomnia has been shown to improve sleep.
Sleeplessness, racing thoughts and sudden waves of panic can also come with grief. If worry has become part of your grief, our page on anxiety therapy in Frisco explains how that support works alongside grief care.
Staying connected matters once the calls stop. The APA notes that bereavement support groups and peer support can help people feel less alone and avoid the isolation that raises the risk of prolonged grief. As the second year begins, it may help to think about who will be part of your support once the hospice calls end.
How do you find a grief counselor in Frisco after losing a parent?
If you are looking for a grief counselor in Frisco after losing a parent, we offer free consultations so you can decide whether we are a good therapeutic match.
Before that call, it can help to notice whether the support you have now is still enough. Groups, friends and hospice check-ins carry a lot of people a long way. I would gently encourage you to look for more individualized help if any of these feel true for you:
- Your grief feels heavier as the months pass, rather than lighter.
- Sleep, work, eating or caring for others keeps slipping.
- You feel disconnected from yourself, or numb in a way that worries you.
- The death was sudden, frightening or traumatic, and certain memories keep replaying.
Not every therapist has the same depth of grief training, so it is fair to ask about it directly. Depending on what a client needs, our grief therapists use mindfulness and grounding tools, trauma-focused CBT, self-compassion work, attachment-focused therapy and EMDR.
For grief that has become prolonged, the American Psychiatric Association reports that treatments using elements of cognitive behavioral therapy have been found to reduce symptoms. One of them, Prolonged Grief Therapy, focuses on accepting the reality of the loss and working toward goals and a sense of satisfaction in a life without the person who died.
We tell clients that weekly sessions for 12 weeks is a standard length of time for therapy to make significant progress on a treatment plan. Timelines vary with the complexity of the trauma and the counseling approach, and clients with complex trauma may take longer.
Ask which therapeutic approaches a counselor uses. EMDR, or eye movement desensitization and reprocessing, is a therapeutic approach that helps the brain reprocess distressing memories, and it is sometimes used when a death was traumatic. Pay attention to whether you feel steady and respected in the first conversation, since a strong working relationship with your counselor is part of what helps therapy work. A 2018 meta-analysis led by Christoph Flückiger in the journal Psychotherapy, covering 295 studies and more than 30,000 participants, found that this working relationship, called the therapeutic alliance, correlated with better outcomes in face-to-face and internet-based therapy alike.
Groups still have a place alongside therapy. A group and individual counseling can work well together.
Cost is often the next worry. Sessions with our therapists can be as little as a co-pay. We take most major insurance plans. Call and ask about your coverage. Most of our clients use insurance: at least 80%, by our estimate. For self-pay, sessions with a licensed professional counselor are $165 ($185 for the first session, 75 minutes), and sessions with a licensed professional counselor associate are $125 ($150 for the first session). We also offer sliding scale therapy. Associates are fully vetted by the state before they are licensed, including national exam scores, a background check, the Texas Jurisprudence Examination and a supervised 1.5-year academic internship with real clients, so each one begins with at least 1.5 years of experience as a counselor. Working with an associate also brings you the experience their supervisor has built over many years.
If a teenager in your family is grieving the same loss, our page on therapy for teens in Frisco explains how we support younger family members. When you are ready, you can call our office at 469-238-2686 to get started directly.
What if grief after hospice starts to feel like trauma, and you want a therapist near Frisco?
When grief after hospice starts to look like trauma, a therapist trained in trauma care can help. License letters tell you nothing about a therapist's warmth or specialties, or how they can support you.
If you are nearing the end of your hospice's bereavement support, it may help to ask yourself whether your grief now includes signs of trauma. Planning for the months after that support ends, especially the second year, can keep that stretch from catching you off guard. If your grief feels heavier rather than lighter as that point approaches, it is a good time to reach out.
Some grief carries signs of trauma. Memories of the final weeks may replay without warning. You may notice hypervigilance, which means feeling constantly on guard, as if something else is about to go wrong. If that sounds familiar, trauma therapy may fit your needs better than a support group alone.
Our practice offers grief counseling for hospice families, bereavement counseling, trauma and EMDR therapy, and grief support after stillbirth or infant loss, in person in Frisco and by video across Texas. So far in 2026, 37.65% of our clients have met with us virtually, and the rest in person. If you work with a licensed professional counselor associate, you receive the associate's training plus the years of experience their supervisor has accrued. We offer free consultations so you can decide whether we are a good therapeutic match, and you can call our office at 469-238-2686 to get started directly. We work very hard to see new clients the same week they reach out, or the following week.
If you are in crisis or thinking about harming yourself, call or text 988 to reach the 988 Suicide & Crisis Lifeline right now.
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Frequently Asked Questions
What else do people ask about grief support after hospice?
Families leaving hospice care often have practical questions about what comes next.
Can I keep getting grief counseling after hospice bereavement services end?
Yes. Grief does not have to fit inside a hospice program's calendar. Our team offers free consultations so you can decide whether we are a good therapeutic match, and you can call our office at 469-238-2686 to get started directly. We work very hard to see new clients the same week they reach out, or the following week.
Is there a trauma therapist near Frisco for PTSD after a loss?
Our practice offers trauma and PTSD therapy, EMDR and Cognitive Processing Therapy, a therapeutic approach that helps you notice and gently rework painful beliefs about a traumatic event. Sessions are available in person in Frisco and by video across Texas. If watching a long illness left you shaken, that is something we can explore together.
Can I schedule therapy in the evening?
Yes. We offer evening and after-school appointments, so sessions can fit around work and school.
Do you see teens who lost a parent or grandparent in hospice?
Yes. We provide therapy for teens who are grieving, and our team can tell you which therapist is the best match for your teen's age and needs. A teen's grief deserves its own space, separate from the adults who are grieving the same person.
Is a support group enough, or do I need a therapist?
Groups can be a real comfort. A group and individual therapy can work side by side, and individual sessions make sense when grief keeps disrupting your sleep, work or relationships.
Written by
Bonnie King
PhD, LPC-S, CSC
Bonnie King, PhD, LPC-S, CSC, has practiced as a counselor since 2010, working with children, adults, and teens with a variety of mental health concerns, including trauma, mood disorders, and specific concerns related to LGBTQ+ marginalization.
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