Hospice exists to improve quality of life for people struggling with serious illness. It offers such immense relief and support. Many families wonder why they did not start sooner and how long does hospice last.
According to the National Hospice and Palliative Care Organization, the average patient spends ninety days in the program. Roughly a quarter spend only seven, hardly enough to benefit from the immense comfort it provides. Families sometimes hesitate to contact a provider. They think hospice care is only for people right at the end. In reality, anyone diagnosed with a terminal disease can request help at any time. As soon as two doctors (a primary care physician and a hospice physician) agree the illness has reached a terminal prognosis, hospice care arrives within 24-hours. In most cases, the hospice team arrives the very same day.
In most cases, Medicare pays for hospice. This unlocks a vast array of resources. However, Medicare only assigns funding to people who can demonstrate a reasonable need for end-of-life care. The patient’s condition will be reviewed after 180 days. A nurse practitioner or doctor will visit to gather more data if the condion does not get worse. If they determine the disease is likely to finish running its course within another six months, the service will continue as before. However, sometimes the patient reaches a plateau or is even showing signs of improvement (eating more, putting on weight, no infections). In this case, they will give them an extended prognosis and prepare them for discharge.
Many patients are understandably upset at receiving an extended prognosis. However, they have the right of appeal. It must be filed with a Quality Improvement Organization (QIO) by midnight on the day of discharge. QIOs are staffed by clinicians, consumers, and medical experts who monitor government health services. They will make their decision within two days. The patient can appeal to a Qualified Independent Contractor and then the Office of Medicare Hearings.
If the patient is finally discharged, the hospice team will do their best to hand off care smoothly as possible. They will notify the patient’s primary care physician and make an appointment with their old insurance carrier. Hospice workers will provide a list of the patient’s medications. They also make sure their prescriptions are fully stocked before they go. If they provided any special equipment, like a hospital bed, the team will tell the family how to acquire it.
It is not unusual for patients to be discharged from hospice and palliative care. The program provides such vigorous support that patients do sometimes improve. Fortunately, being discharged does not prevent them from returning later. Once the patient meets criteria again, Medicare will resume their funding.
Hospice is an elective benefit. Patients can leave any time they want and several do. Normally it is because they decide to pursue aggressive treatment.
However, it must be remembered that moving in and out of hospice is hard on patients. The program provides immense medical, psychological, and spiritual benefits. These are designed to ease pain, maximize comfort, and alleviate grief. Before revoking hospice, families should have an honest talk about the health and interests of their loved one. If they have questions about the disease or the impact of aggressive treatment, they should consult the hospice team or primary care physician.
Asking “how long does hospice last” can make families uncomfortable. Sometimes they think it hastens someone’s passing. Often the opposite is true, however. With access to such dedicated resources, patients normally last longer in hospice than they would otherwise. So, given the circumstances, families should consider which type of care will best provide for their loved one. What will they want their life to look like six months from now? Do they want to remain close to their family? Would they be more comfortable at home or in a medical facility? The answers will tell them whether it is the right choice and how long they should continue with it.
Jose Escobar is the Hospice Executive for Parentis Health. He works with patients and families across Southern California, providing support and education, in order to alleviate the pain and suffering of chronic and terminal illness.