Hospice care is a specialized approach to medical treatment that shifts the focus from curing a terminal illness to providing comfort, known as palliative care. This philosophy prioritizes pain relief, symptom management, and emotional and spiritual support for the patient and their family. Many people view hospice admission as a final, irreversible step, but this is a misunderstanding of the benefit’s structure. It is entirely possible for a patient to leave hospice care and resume life outside of that status.
Understanding Hospice Eligibility
Admission to hospice care is governed by specific medical and regulatory criteria, primarily established by Medicare, which covers the majority of hospice services in the United States. To qualify for the Medicare Hospice Benefit, a patient must be certified as terminally ill by both their attending physician and the hospice medical director. This certification requires a clinical judgment that the patient has a prognosis of six months or less to live.
This projected timeline is based on the expected course of the illness, assuming the disease progresses naturally without further curative intervention. The six-month prognosis is a medical estimate, not a guaranteed endpoint, which is a distinction in understanding how patients can improve. Eligibility is reviewed periodically, beginning with two initial 90-day benefit periods, followed by unlimited subsequent 60-day periods.
Before each period renewal, a physician must recertify that the patient continues to meet the terminal illness criteria. Recertification requirements acknowledge that the trajectory of many terminal illnesses can be unpredictable. The nature of the care, which provides intensive symptom management and emotional support, can sometimes lead to an unexpected stabilization of the patient’s condition.
The Path to Improvement and Discharge
There are two distinct mechanisms by which a patient can leave hospice care: a medical discharge or a voluntary revocation of the benefit. A medical discharge occurs when the hospice’s clinical team determines the patient no longer meets the eligibility criteria for a terminal prognosis. If the patient’s condition stabilizes or improves to the point where their life expectancy is now estimated to be greater than six months, the hospice provider is required to discharge them.
This is often referred to as a “live discharge for stabilization” and requires a written physician’s discharge order from the hospice medical director. The hospice team must engage in discharge planning, which includes preparing the patient and family for the transition to other care settings, such as home health or palliative care. This process is intended to be gradual, allowing the interdisciplinary group time to assess stabilization and plan for ongoing support.
Alternatively, a patient or their representative can choose to revoke the hospice benefit at any time and for any reason. This voluntary revocation is the patient’s choice, and the hospice cannot prevent or demand it. The patient may choose revocation because they wish to pursue curative treatments, such as a new chemotherapy regimen or a surgical procedure, which are not covered under the hospice benefit.
Revocation requires the patient to sign a written statement with the effective date, after which the hospice stops providing services. This process grants the patient full control over their medical choices and allows them to immediately shift their focus back to curative or aggressive care options.
Life After Hospice Discharge
Once a patient is discharged or revokes the hospice benefit, they immediately resume the general coverage that was previously waived. For those covered by Medicare, Part A and Part B benefits revert to covering standard medical services, including hospital stays, doctor visits, and medications for all conditions. This transition is seamless, with the hospice filing a notice of termination with the payer to ensure benefits are reinstated without delay.
The patient can then pursue any form of curative or maintenance treatment, including those that may have been temporarily paused while under hospice care. Following a live discharge for stabilization, the patient may move to a less intensive form of support, such as home health care or palliative care for ongoing symptom management. Palliative care is distinct from hospice as it can be provided at any stage of a serious illness, alongside curative treatments.
Should the patient’s health decline again, they are eligible to re-elect the hospice benefit without any penalty or waiting period. The patient simply needs to meet the eligibility criteria once more, with a physician certifying a terminal prognosis of six months or less. The possibility of readmission ensures that hospice remains an available resource for comfort and support whenever the patient’s needs shift back toward end-of-life care.