Hospice Rules For Discharge

Our family has been told that hospice will keep seeing mom regardless how long she lives.  A friend says that’s not true and hospices do discharge patients.  Who’s right?


Hospice was created to care for those who have a terminal illness, meaning they are expected to die within six months, if the disease runs its usual course.  But, since humans don’t have control over these things, some folks, while obviously declining, will be stubborn and live longer – sometimes over a year!
The key issue is that there must be measurable evidence of decline and that the doctor believes the patient won’t survive another six months from the time of his assessment.  A ‘face-to-face’ evaluation of a patient is mandatory after they’ve been in hospice for six months—it can be done by the hospice’s physician or nurse practitioner.
Some families become quite upset when hospice recommends discharge and want to know why the ‘help’ can’t continue.  Our hospice [Hospice of the Shoals], and probably every hospice, would love to continue seeing everyone until they finally do die, but the law is quite clear:  if the patient isn’t likely to die in within six months, we must discharge them. 
This applies even to people with cancer.  Studies estimate that about 30% of cancers will never kill you.  If you receive the dreaded “Big C” diagnosis, decide against having any chemotherapy, but are then one of that ‘lucky’ 30% and show no decline after six months in hospice, you could expect to be discharged.  (You could still be readmitted to hospice later if you did start declining.)
The Medicare Hospice Benefit was created to help dying people remain at home, with their pain and other symptoms adequately controlled.  It was never meant to be a ‘custodial’ service, such as what nursing homes provide; meaning they keep people clean, dry, fed, and comfortable, when they can’t look after themselves, for as long as they live. 
Since all taxpayers are paying for the hospice benefit, if we want to ensure it’s there when our turn comes, we have to follow the rules and not abuse the service. 
The bottom line:  if a person is not likely going to live another six months, they deserve to be in hospice [which improves their chance of having a more comfortable and dignified death], but if they are stable and are not going to die within that time, they must be discharged, until such time when evidence of further decline becomes obvious.