So, a terminally ill friend or family member living in Fremont, California, was in hospice care, but you’ve just heard that they’ve been discharged. Apparently, it’s because they no longer qualify – but how could this happen? And is there a way they can return to hospice, or is that door forever closed?
To understand the situation, you need to know the eligibility criteria for Medicare-funded hospice care. Below, the experienced professionals at Suncrest of Fremont discuss the requirements
Who Qualifies for Hospice Care?
To be eligible for Medicare-funded hospice care – or to have the costs of hospice covered by Medi-Cal, military benefits or a private health insurance plan – patients must meet certain criteria. The requirements are:
- A diagnosis of a terminal or life-limiting illness, such as cancer, liver disease, dementia or heart failure
- A life expectancy of six months or less, assuming the illness follows the usual path of progression
- A willingness to forgo curative or life-sustaining treatments, like surgery, radiation or chemotherapy
Once a Fremont physician has certified that a patient has a terminal illness and is expected to live for no more than six months, a hospice medical director is called upon to confirm that assessment. From there on, the patient is considered eligible for hospice care and services can begin.
Does the Medicare Hospice Benefit Have a Time Limit?
The Medicare hospice benefit was designed to make care services available for six months. That’s the guideline the Medi-Cal program, the Veterans Administration and most private insurance providers follow as well. With that being said, hospice care isn’t limited to six months.
Hospice benefits are initially provided for two 90-day benefit periods. After that, anyone who continues to meet the eligibility criteria can continue to receive services for an unlimited number of 60-day benefit periods.
So, there’s no limit to the amount of time someone can be on hospice – but there’s also no guarantee that every patient who qualifies can remain in hospice care for at least six months. Some people in Fremont are discharged early, with the decision to end services made by either the hospice agency or by the patient and their family.
Why Might Someone Be Discharged from Hospice?
A live discharge is the official term used to refer to a hospice patient who is disenrolled while alive. In Fremont, live discharges occur for a number of reasons, including:
- The patient’s health improves or stabilizes to the extent that they no longer have a prognosis of six months or less
- The patient chooses to revoke care services in favor of aggressive treatments intended to cure their illness
- The patient moves out of the agency’s service area or decides to transfer to a different local care provider
- The patient or someone they live with is abusive, disruptive or uncooperative, affecting the delivery of care services
Live discharges are often due to decertification, meaning that the patient is no longer considered terminally ill. But in actuality, most people who are decertified still have the same terminal diagnosis that initially qualified them for hospice care in the first place. They’re still nearing the end of life, too, just not within the expected six-month time frame.
In any case, whether patient- or hospice-initiated, research puts live discharge rates somewhere between 5 and 23 percent. Roughly one out of every seven people who enter hospice are disenrolled, but that figure accounts for patients who become disqualified for hospice care as well as individuals who relocate, those who choose to transfer to a different provider and people who want to once again pursue curative care.
Can People Who Leave Hospice Return at a Later Date?
Live discharges are frequently presented in a positive light, with patients described as “graduating” from the hospice program. The reality is quite different, as the majority of these individuals are still terminally ill and not long for this world. For many, the care transition can be quite challenging.
When a Fremont patient is disenrolled from hospice by choice or as a result of decertification, home visits from members of the care team are discontinued. The provided medical equipment is moved out of their home, too, and the costs of hospice services are no longer covered by Medicare, Medi-Cal, military benefits or private insurance.
Fortunately, this situation isn’t necessarily permanent. If someone chooses to leave hospice to resume the search for a cure or if they become disqualified for care, the door remains open. Returning later on is always an option, provided the individual meets the eligibility criteria. And, patients can opt to work with their original hospice agency or a different care provider.
Do You Have Questions About Hospice Care?
Regardless of why your terminally ill friend or family member was discharged from hospice care, they’ll still need your support. Learning more is a good way to look after your loved one’s interests, and the professional team at Suncrest of Fremont is always available to answer any questions you may have. To discuss hospice care with a friendly and knowledgeable professional, contact us today.
