Live Comfortably - January 21, 2025
By Kathie Miller
This is one of the most common and pressing questions about hospice care. This concern over a perceived hospice time limit causes families to delay starting hospice care, thereby missing out on its full benefits. While hospice is typically intended for patients with a life expectancy of six months or less, you might be wondering if you or a loved one can be in hospice for more than six months.
As long as a physician certifies that hospice care is still appropriate, patients can continue to receive support for as long as needed. This flexibility is crucial because the focus of hospice care isn’t on the timeline but on providing comfort and dignity during a challenging phase of life. Starting hospice care sooner rather than later allows patients and families to maximize the support, guidance, and relief that hospice teams offer. This ensures a better quality of life throughout the journey.
Hospice care is structured into benefit periods, which are designed to ensure that patients receive appropriate care tailored to their evolving needs. For patients receiving hospice through Medicare, the benefit periods begin with two initial 90-day periods. After these, care transitions into renewable 60-day periods. At each stage, a physician must certify that the patient remains eligible for hospice care based on their condition.
During the first 90-day period, the hospice team focuses on assessing the patient’s needs and developing a personalized care plan. If the patient’s condition warrants continued hospice services after the initial period, a second 90-day period begins with a recertification by the attending physician and hospice medical director. This process ensures that the patient continues to meet Medicare’s criteria for hospice care, which typically includes having a terminal illness with a life expectancy of six months or less if the disease follows its natural course.
Once the two 90-day periods are completed, the patient can continue receiving care in 60-day benefit periods for as long as they remain eligible. At the start of each new period, the hospice team reassesses the patient’s condition and coordinates with physicians to renew the certification. These recurring approvals ensure that patients receive ongoing support while maintaining accountability for care quality. This system offers flexibility for those whose conditions change over time, ensuring they receive the necessary comfort and care throughout their hospice journey.
For more details on Medicare hospice care benefit periods, read Medicare’s site: medicare.gov/coverage/hospice-care.
For those needing hospice care beyond six months, there is no automatic cutoff for services. Hospice care can continue as long as a physician certifies that it remains necessary, ensuring patients receive the ongoing support they need. The hospice recertification process involves regular assessments to confirm eligibility, but it’s designed to be straightforward and patient-focused.
Here are some common questions regarding hospice care and what happens after six months and the process of recertification.
No, patients are not automatically cut off from hospice care after six months. As long as a physician determines that the patient’s condition still meets the eligibility criteria, services can continue indefinitely. Hospice is designed to provide ongoing support based on the patient’s needs, recognizing that the progression of terminal illnesses can be unpredictable.
Hospice recertification is a routine process that ensures patients continue to meet the requirements for care. Physicians assess the patient’s condition to confirm that the illness remains life-limiting, typically with a prognosis of six months or less. Recertification occurs at the end of the first two 90-day periods and then every 60 days thereafter. These reassessments allow hospice teams to adjust care plans as needed and ensure patients receive appropriate support.
Decisions about continued hospice care are made by the patient’s attending physician and the hospice medical director. Together, they review medical records and assess the patient’s condition to confirm eligibility. This collaborative approach ensures that decisions are grounded in medical expertise and tailored to the patient’s specific situation.
Hospice care extension requires documentation that supports the patient’s ongoing eligibility. This typically includes updated clinical notes, physician assessments, and evidence of the patient’s condition, such as symptom progression or new complications. These records are reviewed during each recertification period to demonstrate that hospice care remains necessary.
Recertification occurs at specific intervals: after the first two 90-day benefit periods, it happens every 60 days. These regular intervals provide consistency and reassurance for patients and families. Since the process is straightforward and guided by medical necessity, patients can rest assured that care will not be interrupted as long as eligibility criteria are met.
Hospice care is designed to provide comfort and support during the final months of life, often defined as the last six months. However, the actual duration can vary widely depending on individual circumstances. Factors like the type of illness, its progression, the patient’s overall health and their response to care can all influence how long someone remains in hospice. These variations highlight the personalized nature of hospice services and the importance of tailoring care to each individual’s unique needs.
The specific illness a person is managing significantly impacts the length of hospice care. Chronic conditions such as advanced heart failure or progressive neurological diseases like ALS often have a more unpredictable trajectory than terminal cancer, where the decline may follow a more predictable timeline. Understanding the nature of the illness helps healthcare providers estimate the care period, though outcomes may still vary.
The rate at which a disease progresses can influence the length of hospice care. Some illnesses, such as aggressive cancers, may result in a shorter hospice period due to rapid deterioration. Other diseases, like dementia, often involve a more prolonged decline, which may lead to extended time in hospice.
A person’s baseline health and the presence of other chronic conditions can also affect their hospice journey. Individuals with multiple health challenges may experience faster declines, while those with better overall health might stabilize and remain in hospice care longer.
Hospice care aims to improve quality of life, and, in some cases, individuals may stabilize or even improve enough to pause hospice services. This process, known as “live discharge,” allows patients to leave hospice and potentially return if their condition worsens later. Transitioning out of hospice care is straightforward and reflects the adaptability of hospice services to changing needs.
When hospice care extends beyond six months, services often evolve to meet the changing needs of patients and their families. While the primary focus remains on comfort and quality of life, adjustments may be made to care plans, staffing and the frequency of visits based on the patient’s condition.
Families can expect ongoing assessments to ensure eligibility for hospice continues, as well as updates to treatment plans to address new symptoms or challenges. This phase of care provides flexibility, allowing for continuity of support while acknowledging that some patients may stabilize or improve.
In many ways, extended hospice care continues the same principles as the initial six months, focusing on symptom management and emotional support. However, the care team may adjust the intensity of services depending on the patient’s needs, with additional emphasis on long-term planning and monitoring.
Certain signs, such as continued decline in physical function, ongoing pain, or symptom management needs and the progression of an illness, indicate that hospice care should remain in place. Regular evaluations ensure that patients receive the appropriate level of care throughout their journey.
Occasionally, a patient’s condition stabilizes or improves to the point where hospice care is no longer required. Increased mobility, improved appetite or reduced dependency on medications may signal that a transition out of hospice care is appropriate. In these cases, patients can “graduate” from hospice and return if needed in the future.
If a person receiving hospice care lives longer than the initially expected six months, their care does not automatically stop. Hospice providers conduct regular evaluations to determine if the individual still meets the eligibility criteria, which typically require a physician’s certification that the patient has a life expectancy of six months or less if the illness runs its natural course. As long as these criteria are met, patients can continue receiving hospice care indefinitely.
Yes, hospice care can be extended indefinitely as long as the patient continues to meet the eligibility criteria. Hospice care is designed to support individuals with a life expectancy of six months or less if their illness follows its natural course. However, many conditions have unpredictable trajectories and some patients may live far longer than initially expected.
To remain in hospice care, the patient must undergo periodic evaluations, during which a physician certifies that their condition still qualifies them for hospice services. If eligibility is confirmed, care is seamlessly extended, ensuring ongoing support. This system allows patients and families to focus on comfort and quality of life without worrying about interruptions in care, even if the hospice period extends well beyond the standard timeframe.
Most insurance plans, including Medicare, and Medicaid, cover extended hospice care as long as the patient continues to meet eligibility requirements. This means that a physician must certify that the patient’s life expectancy remains six months or less if their illness runs its natural course. As long as these certifications are updated regularly, insurance will typically continue to pay for hospice services. However, coverage specifics vary by plan, so families should review policy details and confirm with their insurer what services are included and any potential out-of-pocket costs.
If a patient’s condition improves while receiving hospice care, they may no longer meet the eligibility criteria. In such cases, they can be discharged from hospice care—a process often referred to as “live discharge.” This occurs when a patient stabilizes, shows significant improvement, or no longer has a life expectancy of six months or less.
The transition out of hospice is straightforward and involves coordination between the hospice team and the patient’s healthcare providers to ensure continued care if needed. For example, a patient might return to curative treatments or other forms of palliative care. It’s also worth noting that if their condition worsens later, they can re-enroll in hospice care without difficulty. This flexibility ensures patients receive the appropriate level of care as their needs evolve.
Yes. When people think of hospice care, they often associate it with end-of-life support. However, not everyone who enters hospice remains there until the end. In some cases, patients improve significantly, stabilize or recover to the point where hospice care is no longer necessary. This is a process often referred to as hospice graduation.
The process of leaving hospice care is simple and coordinated by the hospice team. Patients are discharged after a thorough assessment by their care team and physician. Upon discharge, they may return to previous treatments, shift to a different form of palliative care, or simply continue managing their condition with the support of their regular healthcare providers.
When it comes to hospice care, there are two distinct situations in which a patient may stop receiving services: graduating from hospice and revoking hospice. While both involve discontinuing care, the reasons behind each decision and the patient’s condition are different.
Revoking Hospice: This occurs when a patient or their family chooses to discontinue hospice care, often because they want to pursue curative treatments, seek different types of care or have experienced a change in circumstances or condition. It’s typically a voluntary decision made to explore other options.
Graduating from Hospice: This happens when a patient no longer meets the eligibility criteria for hospice care because their condition has improved. For example, if a patient’s health stabilizes or improves significantly, they may “graduate” from hospice care because they no longer need the comfort-focused services that hospice provides. In such cases, the hospice care team will discharge the patient, but the patient can always re-enroll in hospice care if their condition worsens again.
In short, revoking hospice is a choice to stop care, while graduating from hospice is a result of the patient’s improved health, meaning they no longer qualify for hospice services.
Re-enrolling in hospice care after it has been paused is a relatively simple and common process. If a patient’s condition improves enough to temporarily leave hospice – but later worsens – re-enrollment is often straightforward. The hospice care team will assess the patient’s current health status, and if they meet the eligibility criteria again, hospice services can resume without difficulty.
This process happens regularly and is designed to be flexible. Hospice teams are experienced in managing these transitions and will work closely with the patient, family, and healthcare providers to ensure seamless re-entry into care.
Delaying hospice care can lead to unnecessary suffering for both patients and families. Waiting too long may result in unmanaged pain, increased discomfort, and emotional stress. The later hospice care begins, the fewer opportunities there are for its full benefits, including pain management, emotional support, and spiritual care. Early enrollment can improve quality of life in a patient’s final days, allowing for greater peace and dignity.
At Goodwin Hospice, our mission is simple, yet powerful: provide the highest-quality, patient-centered care to our hospice patients and their loved ones. We’re proud to offer this level of end-of-life care. We’ve provided it to our residents for more than two decades, and we have offered it to our community, including Alexandria, Arlington, and Falls Church, since 2016. Another benefit for patients in Northern Virginia is that we do not turn away patients who lack financial resources, one of many advantages to our non-profit hospice care model.
Goodwin Hospice is able to deliver the most compassionate care available because of our top-ranked team of Medicare-certified hospice care providers with more than 50 years of experience. From physicians, nurse practitioners, and registered nurses to licensed clinical social workers, spiritual counselors, and bereavement counselors, our team delivers comprehensive care where and when you need it most. And we couldn’t do it without our wide network of dedicated hospice aides and volunteers to support the rest of the team. Our team is unparalleled and patients can clearly see they’re getting top-quality hospice care.
Because Goodwin Hospice believes everyone has the right to die with dignity and comfort, we go above and beyond to deliver exceptional end-of-life care. In addition to pain management and symptom control, personal care, social work services, counseling, spiritual support and 24/7 on-call nursing support, Goodwin Hospice offers a bundle of complimentary compassionate services. These include our friendly visitor volunteers, pet companionship, end-of-life doulas, end-of-life massage therapy and visits from Threshold Choir singers. We also offer bereavement support for the family after their loss.
If you have any questions, we’re here to help at any time. Please contact us at 703.578.7108 or HospiceReferrals@GoodwinLiving.org to ask any questions or get more details about Goodwin Hospice.
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