What is the best course of care for a patient on hospice (hospital care for terminally ill patients) who is still doing well?

Continuing Hospice Care for Stable Patients

Patients who are "doing well" on hospice should continue receiving hospice services, as hospice eligibility does not require imminent death and Medicare will continue coverage beyond 6 months if enrollment criteria remain met. 1

Understanding Hospice Eligibility and Duration

The fundamental misconception here is that hospice is only for patients in their final days or weeks. In reality:

• Medicare and other insurers will continue to reimburse hospice care beyond the initial 6-month certification period if patients still meet enrollment criteria, even when they are stable or "doing well." 1
• The physician's certification of terminal prognosis (likely less than 6 months) does not "guarantee" death within that timeframe—it represents a clinical judgment based on the natural course of disease without curative treatment. 1
• Patients can remain on hospice indefinitely as long as they continue to have a terminal prognosis and meet eligibility requirements, which should be reassessed periodically. 2

What "Doing Well" Means in Hospice Context

When a patient on hospice is "doing well," this typically reflects successful symptom management and quality of life optimization rather than disease reversal:

• Research shows hospice patients often rate their quality of life as "good to very good" within 20 days of admission, with minimal symptom distress when pain, dyspnea, and other symptoms are well-controlled. 3
• The goal of hospice is to help patients live as fully and comfortably as possible in their remaining time, not to hasten or delay death. 1
• Feeling well while on hospice represents successful palliative care, not a reason to discontinue services. 4

Clinical Management Approach

Reassessment Protocol

Conduct regular reassessment to ensure continued appropriateness of hospice enrollment: 1

• Evaluate whether the patient still has a terminal prognosis based on disease trajectory
• Assess if the patient's goals of care remain aligned with hospice philosophy (comfort-focused rather than curative)
• Document ongoing decline or stability in the context of terminal illness
• Consider whether the patient would benefit from recertification for continued hospice services 1

If Condition Has Truly Improved

Only if the patient's condition has unexpectedly improved to the point where they no longer have a terminal prognosis should hospice discharge be considered: 1

• Patients can be withdrawn from hospice programs if their condition unexpectedly improves 2
• This is rare but can occur with certain disease trajectories
• The decision should involve the hospice medical director, treating physician, patient, and family 1

Maintaining Continuity of Care

Continue coordinated hospice services with the stable care team: 1

• Registered nurses should continue onsite visits to evaluate needs and coordinate care 1
• Social workers and chaplains should provide ongoing support 1
• The patient and family remain integral members of the palliative care team 1
• Continuity with a stable care team that knows the patient and family is extremely important 1

Common Pitfalls to Avoid

• Do not discharge patients from hospice simply because they are stable or comfortable—this reflects successful hospice care, not inappropriate enrollment. 3
• Avoid the misconception that hospice is only for the last hours to days of life—earlier and longer hospice enrollment is associated with better outcomes. 2, 5
• Do not assume that "doing well" means the disease has reversed—many terminal conditions have periods of stability before further decline. 1
• Remember that patients do not need to be actively dying or have a DNR order to remain in hospice. 1, 5

Communication with Patient and Family

Provide education about the natural course of hospice care: 1

• Explain that feeling well on hospice is a positive outcome reflecting good symptom control
• Clarify that hospice can continue as long as the terminal prognosis remains
• Reassure that the goal is quality of life, not a specific timeline to death 1
• Address any concerns about "taking up a hospice bed" or feeling they don't "deserve" hospice services anymore