Hospice services should be started as soon as the doctor feels the person is not likely going to live another six months or when a patient with a life-limiting disease believes that more tests and treatments will no longer help and only cause more suffering.
Once a person has a known terminal diagnosis and then begins their ‘downward spiral’ (increasing visits to the doctor or hospital; needing more assistance in daily activities), it is better to enroll sooner than later. With the support of a hospice team, studies now show that patients live, on average, 1 – 3 months longer and with a better quality of life than similar groups not in hospice. This is likely because they’ve accepted life’s approaching end and focus on comfort only, stopping drugs and treatments which are not beneficial.
If a patient lives beyond their expected six months, but is still deteriorating slowly, and if the hospice Medical Director still feels that the patient meets Medicare criteria for hospice they may continue with hospice services.
As of January 1, 2011, Medicare requires the Medical Director to have a face-to-face visit with these patients before re-certifying them. If that person is not declining, hospice is expected to discharge them. However, when they begin to decline again, they can be readmitted into hospice.