Does admission to observation care in a hospital invalidate a patient's hospice status?

Hospital Observation Status and Hospice Eligibility

Admission to observation status in a hospital does NOT invalidate a patient's hospice enrollment. Hospice patients can and should be hospitalized when symptom control cannot be achieved in their current care setting, and observation status is simply an administrative billing designation that does not affect hospice eligibility 1.

Understanding the Distinction

Observation status is a billing and administrative classification, not a clinical care designation that conflicts with hospice philosophy. The key issue is whether the hospitalization aligns with the patient's comfort-focused goals of care, not the billing status assigned by the hospital 1.

• Hospice patients remain enrolled in hospice during hospitalizations when the admission is for symptom management rather than curative treatment 1
• The hospice team should coordinate with the hospital to ensure continuity of the comfort-focused care plan during any hospitalization 1
• Medicare requires patients to agree that hospice care (not curative care) will be used to treat their terminal illness, but this does not prohibit hospitalizations for symptom control 2

When Hospital Admission is Appropriate for Hospice Patients

Hospital admission (including observation status) is indicated when satisfactory symptom control cannot be achieved in the current care setting. This includes 1:

• Severe dyspnea or pain requiring intensive monitoring
• Acute symptom crises beyond what can be managed at home or in the current facility
• Need for specialized procedures focused on comfort (not cure)
• Situations requiring interventions beyond what the current setting can provide

Critical Coordination Requirements

Before any hospitalization, ensure the patient and family understand how the admission fits within their overall hospice care plan. The admission should 1:

• Align with the patient's documented goals of care
• Focus on symptom management rather than life-prolonging interventions
• Involve coordination between the hospice team and hospital staff
• Include palliative care consultation to facilitate appropriate transitions 1

Common Pitfalls to Avoid

The most common error is assuming that any hospital admission automatically disqualifies a patient from hospice. This misconception can lead to 2:

• Unnecessary disenrollment from hospice services
• Gaps in coordinated care during transitions
• Patient and family confusion about their care options
• Delayed symptom management

Another critical pitfall is failing to clarify the purpose of hospitalization with the patient and family beforehand. Without clear communication, families may misinterpret observation admission as a return to curative treatment 1.

Practical Considerations

Observation stays typically last 24-48 hours, which aligns well with short-term symptom stabilization needs for hospice patients. Research shows that observation lengths of stay average 33.3 hours, with many extending beyond 48 hours for complex patients 3. This timeframe is often sufficient for:

• Adjusting pain or dyspnea management regimens
• Stabilizing acute symptoms
• Arranging appropriate discharge back to hospice care at home or in a facility 1

Palliative care consultation during hospitalization can facilitate appropriate transitions and reduce readmission rates, ensuring patients return to their preferred hospice setting with optimized symptom control 1.

Documentation Requirements

When a hospice patient is admitted to observation status, document clearly that:

• The admission is for symptom management consistent with hospice goals 1
• The patient's hospice status remains active
• Coordination has occurred between the hospice team and hospital staff 1
• The patient and family understand the purpose and goals of the hospitalization 1