“I just wonder how individuals deal with getting discharged from Hospice because the patient didn't decline quickly enough for Medicare?” is a question I received recently– and it’s not the first one of its kind I’ve received.

Why is the patient being discharged, you ask? Is it because the patient just didn’t decline as rapidly as expected? Yes, that can be the situation.

Is it because hospice took the patient on to service too soon to keep admissions up? Sometimes that happens too.

Is it because dementia was the main diagnosis for admission? Dementia doesn't play by the rules for determining approaching death. Way too frequently, the person has to be dismissed from the hospice program for no longer meeting Medicare requirements.

No matter the reason for discharge, that discharge leaves the family literally stranded without support. No more nursing visits, no more CNA visits, no more social worker or chaplain visits, no more volunteers. No more access to the “I’m scared and don’t know what to do” on-call service. Added to all that, they now have to figure out a different way to pay for expensive equipment and medications.

One of the things I see missing when patients and families are discharged from the hospice benefit is a lack of information and assistance in getting the services they are losing, which can be (partially) found elsewhere.

When at a team meeting, the discussion is often limited to "this person needs to come off of service." A plan of how to get them different community support needs to become the plan of care. 

Social workers need to increase their visits and outline community support services. Not only to suggest and inform, but also to help them get services established. Address the replacement of equipment, medication delivery, and costs. Discuss the option of palliative care until it is time to return back to hospice. Palliative care doesn't offer financial resources but it does give guidance and support.

Suggest an End of Life Doula. They don’t have the time limitations that hospice services do. End of Life Doulas do charge for their service.  

The point is: PLEASE DON’T LEAVE THE PATIENT AND FAMILY ADRIFT!

Something More... about The Difficulties of Being Discharged From Hospice Care

I have another blog article, Hospice Services Pulled for Dementia Patient, that may be helpful to those whose person with dementia has been discharged from hospice. My resource, How Do I Know You? Dementia at the End of Life  will help with understanding the dying process with dementia.  Here is a recent review of this booklet:

One of the BEST dementia supports available!!

"Working as a Dementia trainer and practitioner for 25 years, I can honestly say this is one of the best dementia resources available on the market! Worded in a way that caregivers and families really get it, it affects positive change for all parties involved. Here, here!" -Kim F.