Hospice care is a specialized form of palliative care focused on comfort and quality of life for a person with a terminal illness. It involves managing pain and symptoms rather than seeking curative treatments. Although it serves as end-of-life care, entering a hospice program is not an irreversible decision. Patients can leave hospice care, either temporarily or permanently.
The Criteria for Entering Hospice Care
A patient must meet specific criteria to be admitted and covered under the Medicare Hospice Benefit, which sets the standard for most private insurance plans. The primary requirement is certification by both the attending physician and the hospice medical director that the patient is terminally ill. This means the patient has a prognosis of six months or less to live if the illness runs its expected course.
This six-month outlook is a medical estimate, not a guaranteed timeline. The prognosis must be re-certified at designated intervals to ensure the patient continues to meet eligibility requirements. If a patient’s condition stabilizes or improves, they may no longer meet the criteria for coverage.
Eligibility requires accepting comfort care instead of treatments aimed at curing the terminal illness. The patient signs an election statement choosing hospice care and waiving the right to Medicare payments for related treatments. Certification is initially for two 90-day periods, followed by subsequent 60-day periods, all requiring recertification of the terminal prognosis.
How Patients Leave Hospice Care
Patients leave hospice care through two main mechanisms: a voluntary decision (revocation) or a determination by the medical team (discharge). Revocation occurs when the individual or their legal representative chooses to end hospice services. This choice is immediate and does not require approval from the medical team or the hospice provider.
Revocation is often chosen when a patient decides to pursue curative treatments again, such as surgery, medication, or a clinical trial. Upon revocation, the individual forfeits the remaining days in that current election period. The patient must provide a signed written statement to the hospice agency to make the revocation official.
The second way a patient leaves is through a medical discharge, which occurs when the hospice medical team determines the patient is no longer terminally ill. This happens if the patient’s condition stabilizes or improves, meaning their life expectancy is estimated to be greater than six months. Improvement can result from aggressive symptom management, improved nutrition, or a beneficial response to the holistic care model.
A discharge due to improvement is an agency-driven decision, requiring a written discharge order from the hospice medical director. The hospice must have a discharge planning process in place, including planning for necessary support and services after care ends. The patient has the right to appeal this type of discharge if they believe services are ending prematurely.
Medical Care After Hospice Discharge
Once a patient is discharged from hospice, whether by revocation or medical determination, the focus of their care shifts back to curative medicine. The patient resumes the Medicare or insurance coverage waived when they initially elected the hospice benefit. This allows the patient to pursue medical treatments, hospital stays, or specialized services aimed at treating their underlying illness.
The patient is free to see specialists and receive aggressive interventions, which are no longer restricted by the hospice’s comfort-care focus. If the patient had a Medicare Advantage plan, their coverage reverts to the standard fee-for-service plan until the first day of the following month, when Advantage plan benefits resume.
If the patient’s condition declines again, they are fully eligible to return to hospice care. There is no penalty for leaving and re-entering the program. The patient simply needs to be re-evaluated and meet the eligibility requirement of a six-month or less prognosis. Re-election of the hospice benefit can occur at any time, provided the patient is medically eligible.