Many patients who receive hospice care are expected to die soon. But research shows that many people now survive hospices. It’s not uncommon for patients in hospice care to get better. Miracles can and do happen. Entering hospice care no longer means that your life expectancy is short. There is life after hospice.
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Do People Come Out of Hospice?
Hospice care is for terminally-ill people who have stopped treatment and expect to die in less than six months. Professional health care providers offer the end-of-life services to prepare people and their families for death.
Hospice care is recommended for patients who have a life expectancy of six months or less. However, there are patients who are discharged from hospice services. According to the Centers for Medicare & Medicaid Services (CMS), in 2014 about 1.3 million patients received hospice care. Although 29% had a diagnosis of cancer, the remaining 71% had other life-limiting diseases. Of all patients, 11% were live discharges. Thirteen percent survived the 6 month period. On average, the length of time patients receive hospice care is 70 days.
It’s not surprising that people survive hospice care. Doctors have great difficulty in predicting when a person will die from a life-threatening disease.
Discharge from Hospice: What’s the Process?
The main reason for discharge is that patients get better after entering hospice services. Some go into remission and are no longer terminally ill. Others improve because of consistent and personal medical care. The staff adjusts medications, manages pain, controls symptoms, and gives emotional and spiritual support. Home hospice often provides nutritious meals, and social interaction.
However, not that there are a variety of other reasons for ending hospice care:
- Patient is hospitalized
- Patient wants to change home hospice service providers
- Patient moves out of area
- Patient resumes treatment options such as surgery, radiation, chemotherapy
In rare instances, home hospice ends because the patient’s household is abusive or disruptive, or there is little cooperation from family members.
At the six-month mark, doctors assess a patient’s health, and if there is no evidence of continuous decline, they discharge the patient.
Related: Easing End-of-Life Suffering: Palliative Care for Late-Stage Illness
Who Makes the Decision to Stop Hospice Services?
Both patients and the hospice staff decide when a person should leave hospice care. A patient’s health is regularly assessed for signs of decline or improvement. Hospices usually decide to discharge a patient who has been receiving services for six months or more and who has gotten better.
Also, most insurance providers, including Medicare and Medicaid, stop benefits after six months. For patients to continue getting hospice care, their doctor has to recertify that they’re still terminally ill.
When hospice ends, the patient no longer receives services at home.
Hospice Discharge: The Planning Process and Tips
The discharge of a patient doesn’t happen overnight. The decision occurs over a period of time. There are ongoing reviews by the hospice staff to determine if the patient is still eligible for hospice care. When a patient continues to improve, there are discussions with the patient, family members, and primary doctor about the next step.
If the medical director of the hospice believes the patient can be discharged, the hospice gives at least a two-day notice. State laws vary on minimum notice time allowed. The medical director also provides a written discharge order and a discharge summary that includes length of care, symptoms, treatments, and pain management.
If patients revoke hospice care, they must present a signed written notice to the hospice. They also sign a form revoking hospice care which includes the final date of care. The assessment of the patient’s doctor is also included in the discharge documents.
For revoking hospice care, follow these tips:
- Plan ahead for any required health services
- Arrange for transportation for the patient to get to services
- Remember that leaving hospice care behind is a good sign
Live discharges are occurring with more frequency. It’s no longer a death sentence when someone needs hospice care.