In order for a person to qualify for hospice care, he or she must have a prognosis that states the person's health will deteriorate with the end-of-life occurring within 6 months. Only one's hospice doctor and one's regular doctor (assuming a patient has one) can certify that one is terminally ill and has 6 months or less to live. The treating doctor will sign a certificate called a 'Certification of Terminal Illness' regarding the 6-month time-frame. Of course, the 6-month determination may be inaccurate; but if a 6-month determination is made, the doctor will have offered his or her best medical opinion for a particular patient.
Medicare tells us the following:
*** You can receive hospice care for two 90-day benefit periods, followed by an unlimited number of 60-day periods.
*** You can change your hospice provider, once, during each benefit period
*** At the beginning of each benefit period after the first 90-day period, the hospice medical director or other hospice doctor must re-certify that you are terminally-ill in order to continue to receive hospice care.
Hospice Care Can Be Re-evaluated
Many people flourish under the care of hospice; and live past the 6-month time-frame. When this occurs, regular case conference meetings take place with the various professionals involved, such as the hospice medical director, nurses, and staff. Going past the 6-month period means a patient must be re-certified showing a progressive decline in their disease trajectory. Each case is carefully evaluated to determine if hospice services should continue or cease.
If patients choose to relieve themselves from hospice care, they can evaluate their specific situation if they decide to undergo aggressive, curative treatment. Those same patients can re-enroll into hospice, if and when, they feel it is in their best interest. A person has the right to stop hospice care at any time; and when that takes place, one would be asked to sign a form that includes the date the care would end.
Six Months and Beyond
The average time in hospice can vary; and, as stated, the prognosis for one's life expectancy must be 6 months or less. As long as a patient meets hospice criteria after the original admission into hospice care, they can remain on hospice until they die. Some patients can, conceivably, meet all hospice criteria for a year or more. The length of time to receive hospice services is dependent on the diagnosis and disease progression of the individual patient; yet, if a patient's health is no longer declining, or if the condition improves, the patient could be officially discharged.
Most hospice services try to stay within a 150-200 day mark to avoid penalties from Medicare. Some insurers or state Medicaid agencies cover hospice for a full year. Sadly, many people do not receive hospice care until the final weeks or even days of life. This, unfortunately, means many individuals miss out on months of helpful, compassionate care as well as increased quality of life.
Just as as side note: The average length of hospice service for Medicare patients enrolled in hospice in 2016 was 71 days. The median length of service was 24 days. Additionally, during that same year, 64% of Medicare hospice patients were 80 years of age, or older.
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