The length of time a person can remain in hospital palliative care is a common concern for families navigating serious illness. Palliative care is specialized medical care provided to people with serious illnesses, focusing on relieving symptoms, pain, and stress to improve the quality of life for the patient and the family. While this care can be offered in many settings, an inpatient stay is usually reserved for acute medical situations. The duration of this hospital stay is not fixed and is determined by the patient’s medical needs and the ability to stabilize their condition.
Defining Palliative Care and Inpatient Hospice
Palliative care and hospice care are often confused, but they serve distinct purposes. Palliative care can be provided at any stage of a serious illness, even from diagnosis, and is offered alongside curative treatments like chemotherapy or surgery. The goal is to manage symptoms and improve comfort while the patient is pursuing life-prolonging therapies.
In contrast, hospice care is a specific type of palliative care reserved for the final stages of a life-limiting illness, typically when a doctor estimates the patient has six months or less to live if the disease follows its natural course. When a patient elects hospice, the focus shifts entirely from curative treatment to comfort and quality of life. Inpatient hospice, sometimes called General Inpatient (GIP) care, is a short-term, intensive level of hospice care provided in a facility, which may be a hospital or a dedicated hospice center.
This distinction is important because the length of stay is managed differently. Palliative care itself is not time-limited and can continue for years as the illness progresses. However, an inpatient hospital stay for palliative care is short-term and medically driven, while GIP hospice care is also short-term and is specifically covered by benefits like Medicare for acute symptom management that cannot be managed at home.
Criteria for Admission to Hospital Palliative Care
Admission to a dedicated hospital palliative care unit, or receiving intensive palliative consultation while in the hospital, is based on a need for acute, complex symptom management. This level of care is medically necessary when a patient’s symptoms cannot be controlled in a less intensive setting, such as at home or in a skilled nursing facility. The criteria for admission are about the complexity and severity of the symptoms, not the overall duration of the illness or a predetermined time limit.
Common reasons for admission include a severe pain crisis that requires intravenous medication titration and frequent assessment, or intractable nausea and vomiting that leads to dehydration. Respiratory distress that necessitates specialized treatments, or a diagnostic workup needed to clarify the goals of care, also qualify a patient for an acute hospital stay. The hospital setting provides the necessary resources, such as 24-hour physician and specialized nursing care, to address these complex needs quickly.
Admission may also be considered for patients with difficult-to-control emotional symptoms, severe psychological distress, or complex psychosocial needs that cannot be adequately addressed in a community setting. The intensive hospital environment allows the interdisciplinary team to stabilize the patient. These stays are meant to resolve the immediate crisis so the patient can transition back to a lower level of care.
Factors Determining Length of Stay
There is no fixed time limit, such as 5 or 30 days, for a hospital palliative care stay; the duration is determined solely by medical necessity. The stay is authorized to continue only as long as the patient requires the highly specialized resources of the acute care hospital setting. The primary goal is achieving stabilization, meaning the patient’s acute symptoms, such as uncontrolled pain or severe shortness of breath, have been brought under control.
Once symptoms are stabilized and the patient is medically able to be moved, they no longer meet the criteria for a hospital level of care. Hospitals are designed for acute treatment, and policies set by insurance providers like Medicare authorize inpatient days based on the need for round-the-clock medical interventions. If the acute crisis is resolved, insurance coverage for the hospital stay will generally cease.
Studies analyzing hospital palliative care unit stays show that the median length of stay can vary, with some research indicating a median of around 15 days. This duration is highly dependent on the patient population and the specific unit’s focus. Factors such as severe mobilization limitations, the need for tube feeding, or the presence of a permanent tracheostomy may be associated with a longer stay.
Transitioning Care When the Hospital Stay Ends
Once the acute medical crisis that led to the hospital stay is stabilized, the focus shifts to comprehensive discharge planning. The patient no longer requires the high-intensity level of care provided by a hospital but still needs continued support. The discharge plan determines the most suitable next location for ongoing comfort and symptom management.
Transfer options typically include returning home with increased home health services and equipment, or moving to a skilled nursing facility (SNF) for subacute care or rehabilitation. Another common transition is a transfer to a dedicated hospice residential facility, especially if the patient meets hospice eligibility criteria. The interdisciplinary palliative care team ensures continuity of care by coordinating with the receiving facility or home care agency.