Can Hospice Patients Be Admitted to the Hospital?
Yes, hospice patients can absolutely be admitted to the hospital when necessary for symptom control or acute management, and this does not require disenrollment from hospice. 1
When Hospital Admission Is Appropriate for Hospice Patients
Hospital admission for hospice patients is specifically indicated when satisfactory symptom control cannot be achieved in the current care setting. 1 The American Thoracic Society explicitly states that "in some instances, a hospice patient may have to be admitted to the hospital to achieve satisfactory symptom control." 1
Key Scenarios for Hospital Admission
- Severe dyspnea or pain that cannot be managed with available resources at home or in the hospice facility 1
- Acute symptom crises requiring intensive monitoring or interventions beyond what can be provided in the current setting 1
- Need for specialized procedures or diagnostic workups that align with comfort-focused goals of care 1
Important Clarifications About Hospice and Hospital Care
Hospice Does Not Require Complete Withdrawal from Medical Care
A critical misconception is that hospice enrollment means patients cannot receive any hospital-level care. 1, 2 Patients in hospice programs do not need a "do not attempt resuscitation" order to be enrolled, and it is actually illegal under the Patient Self-Determination Act for Medicare-funded hospice programs to exclude patients who don't agree to forgo CPR. 1, 2
What Changes with Hospice Enrollment
- Patients must agree in writing that hospice care (not other Medicare services for curative treatment) will be used to treat their terminal illness 1, 2
- The focus shifts from curative to comfort-oriented care, but this does not eliminate all medical interventions 2
- Palliative treatments for symptom management continue and are often enhanced, including supplemental oxygen, medications for symptom control, and other quality-of-life interventions 2
Practical Considerations for Hospital Admission
Coordination of Care
When a hospice patient requires hospitalization, the hospice team should coordinate with the hospital to ensure continuity of the comfort-focused care plan. 1 The American Academy of Hospice and Palliative Medicine emphasizes that palliative care consultation during hospitalization can facilitate appropriate transitions, including discharge back to hospice care at home. 1
Financial Implications
- Medicare and other insurers cover hospice care under specific per diem rates that include most services related to the terminal illness 1, 3
- Hospital admissions for hospice patients may involve complex billing considerations, as hospices are responsible for covering costs related to the terminal condition 3
- Some situations may require temporary disenrollment from hospice if the hospitalization is for curative treatment of the terminal illness, though patients can re-enroll when appropriate 1
Common Pitfalls to Avoid
Misconception About Hospice Being "End of Care"
Many incorrectly believe hospice care is only for the last hours to days of life, when in fact earlier referral is associated with better outcomes and allows for more comprehensive symptom management. 2, 4 This misconception can lead providers to inappropriately discourage hospital admission when it would genuinely improve symptom control.
Failure to Communicate Goals of Care
Hospital admission should align with the patient's documented goals of care. 1, 2 Before any hospitalization, ensure that the patient and family understand:
- The purpose of the admission (symptom control vs. curative treatment)
- How the hospitalization fits within their overall hospice care plan
- What interventions will and will not be pursued during the hospitalization
Not Utilizing Palliative Care Consultation
If a hospice patient is admitted to the hospital, palliative care consultation should be obtained to help navigate complex symptom management and ensure alignment with hospice philosophy. 1 This consultation can reduce 30-day readmission rates and facilitate appropriate discharge planning back to hospice care. 1
Settings Where Hospice Care Can Be Provided
Hospice care is not limited to home settings and can be delivered in multiple locations based on patient and family needs: 1, 5
- Patient's home (most common preference)
- Long-term care facilities
- Dedicated hospice facilities
- Hospitals when needed for symptom control 1, 5
The determinants of where patients die often relate to local health system resources, including availability of acute hospital beds and hospice resources, rather than solely patient preference. 1