Is accepting hospice under Medicare "choosing to die"?
Expert Answer by Joseph L. Matthews
Hospice is a type of care that focuses on relieving pain and other suffering for patients nearing the end of life. To qualify for Medicare-covered hospice care, a patient's treating physician must certify that the patient's illness is likely to be terminal within six months. Once hospice care is begun, there's no more medical treatment for the terminal illness itself.
Given this requirement of a prognosis of only six months to live, and the ending of treatment for the terminal disease, many people resist hospice because it seems like "choosing to die." Many people also fear hospice because they believe that all medical care will end. For several reasons, though, neither one of these fears should stop someone from choosing hospice care.
In the first place, the decision to choose hospice isn't final. If a patient's condition stabilizes or improves, he or she can give up hospice and return to regular Medicare coverage. All it takes is to have a change of mind about giving up treatment, or a doctor's advice to try a new treatment. Or for some reason the patient might not like hospice care and prefer to return to regular Medicare coverage. Patients don't have to give Medicare or the hospice provider a reason -- they can end hospice and return to regular Medicare coverage at any time.
Choosing hospice does not mean giving up treatment -- and Medicare coverage -- for all illnesses or conditions that a patient might have. If he or she has any medical problem other than the terminal illness itself, he or she can receive normal treatment for it and have it covered by Medicare Part B.
Also, hospice provides patients with specialized medical treatment for any symptom of the terminal disease. This care includes any drug needed to stay as comfortable as possible, provided directly by hospice, without having to go to the pharmacy, get a doctor's prescription, or use other insurance coverage. The same is true for medical equipment such as a hospital bed, wheelchair, walker, or the like.
Answer
Hospice will treat signs and symptoms of illness such as a bladder infection or cold/pneumonia. What they won't do is order test such as blood work or a chest xray. An xray is only done if there is a chance a bone is broken. There main goal is to make you comfortable and to support your family. The Hospice staff monitors your status daily.
Answer
Another reason why hospice care may end is if the patient gets better. The hospice medical director is responsible for determining if a patient has improved enough to be discharged (graduated) from hospice because death is now expected to be more than 6 months away. The hospice team is responsible for making sure there is a treatment plan in place on discharge. The patient continues treatment with their primary care provider. The patient may go back into hospice at any time.
Hospice care can also last more than 6 months if the patient does better than expected. The medical director of the hospice certifies that death is still expected with in 6 monthes. Doctors can only state what they expect to happen in the usual course of life and death, we are frequently wrong when trying to determine a more specific time.
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