Nurses often use the term “Hospice graduate” to describe patients who, during hospice care, improve to the extent that they no longer qualify for hospice. Hospice graduates discharge from hospice alive. Most people, it seems, hope for longer life and for longer lives for their loved ones. Roughly 5% of patients misinterpret hospice as a form of giving up. Discussing the situation of hospice graduates can help shed light on several aspects of hospice care.

Who Qualifies for Hospice?

First, a quick review of hospice qualifications may be in order. To qualify for Medicare-funded hospice, a doctor must estimate the patient’s life expectancy to be six months or less, and there are often disease-specific conditions that must be present to validate the estimate. 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.

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   

Not All Live Discharges are Hospice Graduates

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. In the rates shown above, there are other reasons people would discharge from hospice alive. These include transferring to another hospice, patient choice, becoming ineligible for hospice due to resuming curative treatment, or transferring to an inpatient facility such as a hospital or a nursing home.

The Goal of Hospice is Quality of Life

With all of this, it is important to note that the goal of hospice is not to affect length of life. Hospice does not shorten life. In fact, people receiving hospice tend to live longer by days to months. Nevertheless, this is a byproduct of the true hospice purpose. Hospice works to improve quality of life during end-of-life care. It accomplishes this through improved symptom control, support for family caregivers, emotional support, bereavement support, and other palliative care.

References

1. LeSage K, Borgert AJ, Rhee LS. Time to death and reenrollment after live discharge from hospice: a retrospective look. Am J Hosp Palliat Med. 2015;32(5):563–567.
2. Kaufman BG, Sueta CA, Chen C, Windham BG, Stearns SC. Are trends in hospitalization prior to hospice use associated with hospice episode characteristics? Am J Hosp Palliat Med. 2017;34(9):860–868.
3. Wu S, Volker DL. Live discharge from hospice: a systematic review. Journal of Hospice & Palliative Nursing. 2019 Dec 1;21(6):482-8.