Hospice care offers a specialized approach to medical support for individuals facing a life-limiting illness, focusing on providing comfort and enhancing the quality of life rather than pursuing curative treatments. A dedicated team of professionals delivers physical, emotional, social, and spiritual support to both the patient and their family. The primary goal of hospice is to manage pain and other symptoms, ensuring the patient remains as comfortable and alert as possible during their final stage of life. This care can be provided in various settings, including the patient’s home, specialized hospice centers, hospitals, or nursing homes.
Circumstances for Discontinuing Care
A person can come off hospice care, a process known as a “live discharge.” This can occur for several reasons, reflecting either the patient’s choice or a change in their medical condition. One common scenario is when a patient experiences unexpected medical improvement, stabilizing to the point where they no longer meet the eligibility criteria for hospice, which typically requires a prognosis of six months or less to live if the illness runs its natural course.
Patients also have the right to voluntarily discontinue hospice care at any time, a process termed “revocation.” They might choose this if they decide to pursue curative treatments, or if they wish to explore other care options. This decision rests entirely with the patient or their authorized representative, and hospices cannot compel them to stay.
Other reasons for discontinuing hospice care, often initiated by the hospice provider, include the patient moving outside the hospice’s service area. In rare instances, a hospice may discharge a patient for cause if their or their family’s behavior is significantly disruptive, abusive, or uncooperative, severely impeding the delivery of care. Such a discharge is typically a last resort, following documented attempts by the hospice to resolve the issues.
Steps to Discontinue Hospice
The process for discontinuing hospice care varies depending on whether the patient chooses to leave or is discharged due to medical reasons. If a patient decides to revoke their hospice benefit, they or their representative must provide a signed written statement to the hospice agency. This statement should include the effective date of the revocation, as verbal requests are not sufficient. The hospice team will discuss the reasons for the decision and ensure the patient understands the implications of discontinuing care.
When a patient is discharged due to medical improvement, the hospice care team conducts an assessment to confirm that the patient no longer meets the eligibility criteria for terminal illness. Following this assessment, the hospice medical director issues a written discharge order. If the patient has an attending physician, their input is sought as part of this process. The hospice then handles administrative steps, including notifying relevant insurance providers of the change in status.
Throughout either process, clear communication between the patient, their family, and the hospice team is important. This ensures all parties understand the reasons for discontinuing care, the steps involved, and what to expect next. The hospice staff are available to guide patients and families through these transitions, providing support and information.
Life After Hospice
Once a patient leaves hospice care, their medical insurance coverage reverts to what it was before they enrolled in hospice. Previous benefits, such as Medicare Part A and B or private insurance, will resume covering medical services. For individuals on Medicare Advantage plans, coverage resumes on the first day of the month following the revocation of hospice benefits.
Patients may transition to various forms of care depending on their improved condition and ongoing needs. Some may return to pursuing curative treatments for their illness, while others might shift to home health care for continued support or palliative care, which focuses on symptom management without the terminal prognosis requirement. A significant number of individuals may even regain enough independence to live without continuous medical intervention.
It is also possible for patients to re-enroll in hospice care if their condition declines again and they meet the eligibility criteria. Many patients who are discharged from hospice due to improvement later return if their health deteriorates. The transition back to regular medical care, or other supportive services, involves both practical and emotional adjustments for the patient and their family, which hospice teams often help to plan for.