While hospice is typically associated with end-of-life care, patients can be discharged from these services. This occurs for various reasons, including an unexpected stabilization of their condition or a personal decision to pursue other care options.
What Hospice Care Involves
Hospice care is a specialized approach focused on providing comfort and enhancing the quality of life for individuals with a serious illness. This care is for those whose illness is not responding to curative treatments or who choose not to pursue them. It prioritizes dignity and patient choice during the final stages of life.
Admission to hospice requires a physician’s certification that the patient has a terminal illness with a prognosis of six months or less. This care is not tied to a specific location; it can be provided in a patient’s home, a nursing facility, or a hospital. A multidisciplinary team delivers hospice services, including doctors, nurses, social workers, spiritual advisors, and volunteers.
Services address physical, emotional, and spiritual needs for both the patient and their family. This includes managing pain and other symptoms, offering emotional and spiritual support, and providing medications, medical supplies, and equipment. The team also educates family caregivers and offers bereavement support after the patient’s passing.
Reasons for Hospice Discharge
Patients can leave hospice care under several circumstances, often referred to as “live discharges.” One common reason is medical improvement, where a patient’s condition stabilizes or unexpectedly improves. This does not mean the underlying illness is cured, but rather that the patient no longer meets the eligibility criteria of a six-month or less prognosis. Improved symptom management, better nutrition, or consistent medical attention in hospice can lead to these positive changes.
Another scenario is voluntary revocation, where the patient or their legal representative chooses to discontinue hospice services. This decision can stem from a desire to pursue curative treatments, participate in clinical trials, or for personal preferences. Patients have the right to revoke hospice care at any time without penalty.
Discharge can also occur if a patient moves outside the hospice’s service area. In such cases, the patient might transfer to a different hospice provider in their new location. While less common, a hospice may also discharge a patient if disruptive or uncooperative behavior interferes with care delivery.
The most frequent reason for hospice care ending is the patient reaching the end of their life. However, live discharges demonstrate that hospice is not always a one-way path. Patients can re-enroll if their health declines again and they meet eligibility requirements. Around 15% of hospice patients are discharged alive.
Life After Hospice
When a patient is discharged from hospice due to medical improvement or voluntary revocation, they transition back to other forms of medical care. Patients whose condition stabilizes may return to their primary care physician or specialists to continue managing their underlying illness. This involves resuming treatments that were paused or discontinued upon entering hospice.
Some individuals might transition to general palliative care, which focuses on symptom management and quality of life without requiring a terminal prognosis. Palliative care can be provided alongside curative treatments, offering an ongoing layer of support for managing chronic or serious conditions. This is a suitable option for those who no longer meet hospice criteria but still need support for their symptoms.
Healthcare providers continue to monitor the patient’s health. If a patient’s condition declines again after discharge, they can re-elect to receive hospice care, provided they meet the eligibility criteria once more. This flexibility ensures that individuals can access the most appropriate level of care as their health needs evolve.