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.
Hospice Comforts Patients for Six Months or More
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 because they think hospice care is reserved for people right at the end. In reality, once a loved one has been diagnosed with a serious disease, they 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 sufficiently advanced stage, hospice care arrives within 24-hours. In most cases, the hospice team arrives the very same day.
In most cases, hospice is paid for by Medicare, which unlocks an almost limitless range of resources. However, Medicare funding is only assigned to people who can demonstrate a reasonable need for end-of-life care. If, after 180 days, the patient’s condition has not worsened, a nurse practitioner or doctor will be sent to gather more data. If they determine the disease is likely to finish running its course within another six months, hospice will continue as before. However, if they see the patient has plateaued or is even showing signs of improvement (eating more, putting on weight, no infections) they will give them an extended prognosis and prepare them for discharge.
Appeal for Ending Care
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. If the patient is unhappy with it, they can appeal to a Qualified Independent Contractor and then the Office of Medicare Hearings.
What Happens After Discharge
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 medication and make sure their prescriptions are fully stocked before they go. If they have provided any special equipment, like a hospital bed, the team will tell the family how to pay for it.
Returning to Hospice
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 has a new prognosis, Medicare will resume their funding.
Hospice Lasts as Long as You Want
Hospice is purely elective. Patients can leave any time they want and several do. Normally it is because they decide to pursue a new treatment or because their family disagrees with the goals of care. Later, if they change their mind, they are always welcome back.
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 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. Questions about the disease or the impact of aggressive treatment can be brought to the hospice team or primary care physician.
The Most Important Questions
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 in a hospital. 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.
Lewis Jackson writes about technology and healthcare. His work provides practical insight into modern medicine and healthy living.