Hospice care is a specific, palliative approach focusing on comfort and quality of life for individuals with a life-limiting illness. Goals shift away from curative or aggressive treatments. Although many believe electing hospice is permanent, a patient can leave care at any time through revocation. This ensures patients and families maintain control over their healthcare choices.
Understanding Hospice Eligibility and Goals
A patient must meet specific medical criteria, largely governed by federal guidelines like Medicare, to be eligible for hospice services. The requirement is that a physician must certify the patient has a terminal illness with a prognosis of six months or less. This certification must be made by the patient’s attending physician and a hospice physician, confirming the condition is no longer responding to curative interventions.
The philosophy of hospice care centers on symptom management rather than extending life through aggressive medical means. Treatments such as chemotherapy or certain surgeries are typically discontinued to prioritize comfort and minimize pain. Care is delivered by an interdisciplinary team, including physicians, nurses, social workers, and spiritual counselors. Electing the hospice benefit means choosing to prioritize comfort over cure.
The Formal Process of Revocation
Leaving hospice care is a formal, patient-initiated action called revocation, which is a protected right under federal regulations. The process requires the patient or their legally authorized representative to submit a signed written statement to the hospice provider. A verbal request is not sufficient to officially end the benefit, emphasizing the need for clear documentation.
The written statement must express the patient’s intent to revoke the hospice benefit and specify the exact effective date. Upon receiving the signed document, revocation becomes effective immediately on the specified date. The hospice provider processes the necessary paperwork, officially ending the patient’s election. This procedure ensures a clear transition, allowing the patient to resume other medical coverage without delay.
Reasons for Discontinuing Hospice Care
Discontinuing hospice care generally results from two main categories: a change in the patient’s medical status or a change in personal choice.
Medical Improvement
In cases of medical improvement, the patient’s condition may stabilize or go into remission, meaning the six-month terminal prognosis is no longer medically supported. This stabilization sometimes occurs because intensive symptom management leads to better overall health. If the patient is no longer considered terminally ill, the hospice must discharge them because they no longer meet the eligibility criteria.
Change in Care Goals
Alternatively, the patient may choose to revoke the benefit due to a change in care goals. A patient might decide to pursue aggressive, curative treatment previously declined, such as experimental drugs, chemotherapy, or surgery. Pursuing curative care automatically requires revocation, as the two types of care are mutually exclusive under benefit rules. Transferring to another hospice agency or being hospitalized for acute care can also prompt a temporary revocation.
Transitioning Back to Standard Medical Care
The immediate consequence of revoking the hospice benefit is the termination of specialized insurance coverage. The patient’s standard insurance coverage (e.g., Medicare Part A and Part B or private insurance) is immediately reinstated for all medical services previously waived by the hospice election. This allows coverage for curative treatments, hospital stays, and medications aimed at treating the underlying illness. Financial responsibility for copayments, deductibles, and non-hospice related medical equipment reverts to the patient and their standard insurance plan.
A smooth transition requires coordinating care with new or former medical providers. The hospice prepares a discharge summary detailing the patient’s treatments, pain management strategies, and current physician orders, which must be forwarded to the attending physician. This documentation is necessary for the primary care physician and specialists to resume managing the patient’s overall health. Patients who revoke their benefit can re-elect hospice care at any time, provided they meet the six-month terminal prognosis requirement.