Is It True That Choosing Hospice Means You've Given Up?

Is it true that when you choose hospice that you are ‘giving up’ and that you cannot be admitted to hospital?

There are really two issues here.

The first is related to ‘giving up’ vs ‘letting go’.  Many people believe that we must ‘battle’ every disease until death occurs and if we don’t, then we are ‘giving up’.

However, studies show that when we have a chronic, life-limiting disease, choosing to ‘let go’ of something incurable and let a power greater than ourselves take over—we actually not only live longer but also more comfortably.

Our hospice staff constantly help patients and their families work through this ‘letting go’ process, thereby reducing suffering. 

The second issue deals with the common myth that hospice patients cannot be admitted to hospital.

Although Medicare encourages hospice patients to remain at home for all care, there are two situations where admission may be necessary (and therefore covered by Medicare):

1) The patient develops an acute problem, completely unrelated to the reason for being in hospice, and which could be relieved or improved significantly with hospital treatment.

For example, someone in hospice with end-stage heart failure falls and breaks a hip. Fixing the hip often allows a faster, more comfortable recovery and return home to be more active for a few months yet, rather than being stuck in bed; surgery is certainly appropriate unless their expected survival is only another few weeks.

2) A patient has symptoms (pain or shortness of breath) related to their hospice diagnosis which are not controlled at home despite increased care from the nurses.  Because their symptoms are ‘uncontrolled’, they could be admitted under hospice to control those symptoms and once stabilized return home again (although sometimes they require palliative sedation, dying peacefully in hospital).

Although it can sometimes be difficult to sort out whether a suddenly uncontrolled problem is related to the diagnosis/reason for being in hospice, it is still inappropriate and against Medicare guidelines for a hospice to either discharge a patient or ask the family to ‘revoke’ [meaning the family requests to withdraw from hospice care], when deciding that a patient can’t be managed at home.  Families need to know that Medicare expects a hospice to still supervise the patient’s care even in hospital and ensure that the patient’s goals of comfort are met.