Hospice Myths & Misconceptions

Patients may be discharged from hospice, also known as a live discharge, if their healthcare provider estimates that they will live longer than six months. This may happen if the patient’s health improves while on hospice, leading their healthcare provider to re-evaluate their prognosis and adjust their life expectancy. 

Other common reasons why patients may be discharged from hospice include:

• Transferring hospice services
• Unplanned hospitalization 
• Seeking curative treatment for terminal conditions 

Additionally, patients can choose to discontinue hospice care at any time.

It is important to note that being discharged from hospice does not prevent the patient from entering hospice again if their health deteriorates in the future. However, recent studies have shown that when live discharges from hospice occur, almost half of the patients die within 6 months. In these instances, some experts argue that it would be more appropriate for these patients to continue receiving hospice care rather than being discharged and then admitted to the hospital shortly afterward. 

Additionally, a 2017 study found that hospices with higher live discharge rates often have higher profits. This has prompted The Centers for Medicare & Medicaid Services to question whether some patients are being admitted to hospice before they qualify in order to increase the hospice provider’s bottom line. On the other hand, CMS is also concerned about the impact of live discharges and the concomitant loss of supportive services on patient quality of life and death.

Ultimately, it is possible for patients to be discharged from hospice while they are still alive, and these live discharges sometimes have the potential to raise multifaceted issues surrounding financial, ethical, and patient care concerns. Live discharge rates vary among hospices and typically rely on the decisions of healthcare providers, not the request of the patients themselves. More substantial oversight will be necessary to ensure that appropriate and ethical care will continue to be upheld in end-of-life scenarios. 

Sources

“What Happens if I Get Better While in Hospice Care?” VITAS. https://www.vitas.com/hospice-and-palliative-care-basics/about-hospice-care/what-happens-if-i-get-better-while-in-hospice-care

“Nearly 1 in 5 Hospice Patients Discharged While Still Alive”. NPR.  https://www.npr.org/sections/health-shots/2017/08/11/542607941/nearly-1-in-5-hospice-patients-discharged-while-still-alive

“Hospice Readmission, Hospitalization, and Hospital Death Among Patients Discharged Alive from Hospice”. JAMA Network Open. https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2818752