It is a common perception that hospice care is a final, one-way path. However, this is not always the case. Individuals can and do leave hospice care alive. While hospice provides comfort and support during a terminal illness, it is possible for a patient’s condition to improve or for their care goals to change, leading to a discharge from services.
Understanding Hospice Care
Hospice care represents a specific approach to medical support for those facing a terminal illness. Its primary philosophy centers on enhancing comfort and quality of life, rather than pursuing curative treatments for the underlying disease. This care model focuses on managing symptoms, alleviating pain, and providing emotional and spiritual support to both the patient and their family. Hospice services are delivered by an interdisciplinary team, which includes physicians, nurses, social workers, and other specialists, all working together to address the patient’s holistic needs.
Eligibility for hospice care generally requires a medical prognosis of six months or less to live, assuming the illness runs its typical course. This prognosis is certified by a physician, often both the patient’s attending doctor and a hospice medical director. While this timeframe guides eligibility, it is not a rigid prediction, and patients may sometimes live longer than six months while receiving hospice support. Hospice care is a type of benefit, not a physical place, meaning services can be provided in a patient’s home, a nursing facility, or other settings.
Reasons for Hospice Discharge
Patients may be discharged from hospice care alive for several distinct reasons. One primary reason is an improvement in health, where the patient’s condition stabilizes or unexpectedly improves to the point they no longer meet the terminal prognosis criteria. In 2019, approximately 51% of live discharges initiated by the hospice were due to the patient no longer being terminally ill.
Another significant cause for discharge is a patient or family choice to revoke hospice services. Patients have the right to discontinue hospice care at any time and for any reason. This might occur if they decide to pursue curative treatments again, relocate outside the hospice’s service area, or simply no longer wish to receive hospice benefits. Patient-initiated revocations accounted for 37.5% of live discharges in 2019.
Discharge can also occur if the patient no longer meets the specific eligibility requirements for hospice care. For instance, if a patient moves out of the hospice’s defined service area, the hospice may no longer be able to provide consistent care. While a transfer to another hospice is possible, it still constitutes a live discharge from the original provider. In rare circumstances, a patient may be discharged for cause if their or others’ behavior in the home becomes disruptive or uncooperative to an extent that prevents the safe or effective delivery of care. Before such a discharge, the hospice must make significant efforts to resolve the issues and document these attempts.
Life After Hospice Discharge
When an individual is discharged alive from hospice, their Medicare coverage for hospice services ends, and any remaining days in that benefit period are typically forfeited. However, their general Medicare benefits are reinstated, allowing them to access other necessary medical services. This transition usually involves returning to conventional medical care, which might include continued management of chronic conditions by a primary care physician or pursuing new curative treatments. Some individuals may transition to palliative care, which also focuses on symptom management and quality of life but does not require a terminal prognosis.
The process of discharge involves careful planning to ensure a smooth transition of care. Hospices work with patients and their families to coordinate next steps, which can include securing necessary medical equipment, supplies, and prescriptions. If a patient’s health declines again in the future and they once again meet the eligibility criteria, they have the option to re-elect hospice care. This re-enrollment process requires a new certification of terminal illness by a physician.