You may have heard that a friend or family member was in hospice but discharged for no longer qualifying. How often does this happen? What’s behind it? Could it happen to you?

Who Qualifies for Hospice?

To qualify for Medicare-funded hospice, a doctor must estimate a person’s life expectancy to be six months or less. Additionally, Medicare administrative contractors often publish disease-specific conditions that must be present to validate the doctor’s estimate.

Is There a Time Limit on How Much Hospice a Person can Receive?

The hospice benefit was designed to make services available for six months. On the other hand, hospice is not limited to six months, and it is not guaranteed to be available for six months. For instance, if a patient receives six months of hospice care and still qualifies for hospice, he or she may be eligible to continue in hospice. If a patient’s condition improves, he or she may “graduate” from hospice.

Some People Experience Improved Health

How can a person become disqualified for hospice? Improved health is one cause. Some patients improve under comfort care to the extent that their prognosis changes. Once the prognosis is longer than six months, a person no longer qualifies for the program. Nurses sometimes refer to these discharges as “hospice graduates.”

Resuming Curative Treatment

It’s important to keep in mind, though, that not all live discharges are hospice graduates. Hospice graduate refers to the specific circumstance in which a person discharges from hospice because that person’s life expectancy has improved. How else can a person become disqualified for hospice? People may also become disqualified for hospice because they resume curative treatments. Patients in hospice are free to resume curative treatment at any time – even on a moment’s notice in emergency situations. These patients will continue to receive quality medical care. They can return to hospice services anytime they again find themselves in a situation where curative treatments have all been tried or are not desired and the prognosis is six months or less.

What Percentage of Patients Discharge from Hospice Alive?

Various studies have measured live discharge rates between 5% and 23%. However, live discharge rates are strongly influenced by rural status, local demographics, and the characteristics between individual hospice programs. When combining the results of multiple locations across the country, on average, about one in seven hospice patients discharge alive.³ Moreover, live discharges include more than people who became disqualified for hospice. It also includes people who transferred to another home hospice, transferred to an inpatient facility, or who discharged from hospice by choice.   

Conclusion: How Can a Person Become Disqualified for Hospice?

For various reasons, including disqualification, about one in seven hospice patients discharge from hospice alive. Disqualification tends to occur when either a patient resumes curative treatments or a patient’s health improves.

Reference

1. Wu S, Volker DL. Live discharge from hospice: a systematic review. Journal of Hospice & Palliative Nursing. 2019 Dec 1;21(6):482-8.