Lessons Learned from Hospice Care: A Personal Journey

“No more operations,” declared Mike Salmon, marking a pivotal moment in January 2026. At the age of 73, Mike had just endured three months of intense medical intervention. This included facing aortic aneurysms, sepsis, and a period of delirium during his stay in intensive care. A subsequent ambulance ride added another alarming aortic aneurysm to the list. The medical team recommended two more risky operations, predicting that if he did nothing, the odds of the aneurysm or sepsis proving fatal were extremely high, possibly within weeks.

Faced with such dire prospects, Mike was shifted into hospice care. Surprisingly, under this new regime, his health improved to the point where he was discharged from hospice care.

Hospice services are designed for patients expected to pass within six months. They focus on comfort rather than curative treatments, typically at home. Families play a critical role in daily care, with 85% reporting high satisfaction with their hospice’s services, which include drug provision, medical equipment, and visits from various healthcare workers.

In the last fiscal year, hospice enrolled over 1.9 million Americans. Approximately 80% of these patients remained in hospice care until their death, often within four weeks. However, nearly 6% were discharged when doctors determined they had stabilized or improved sufficiently to live beyond six months. Mike became part of this group in May, providing key insights into managing care within and outside the hospice system.

Choosing the Right Hospice Agency

Deciding on a hospice agency can significantly impact care quality. In haste, Mike’s family initially chose the first name on a list of providers, assuming all were similar. This decision proved problematic as the agency was often late and repeatedly failed to update erroneous medical records.

Medicare allows switching agencies. Seeking recommendations from neighbors and using quality ratings from Medicare’s Care Compare and the National Hospice Locator can prevent such issues. These resources help identify agencies that best match a patient’s language needs, spiritual beliefs, and response times.

The Potential for Improvement in Hospice

While not fully understood, some patients improve in hospice care. Research indicates patients with conditions like congestive heart failure or lung cancer often live longer in hospice compared to traditional care. Returning home meant Mike could be more active and enjoy homemade meals, helping regain his weight and strength.

Discharge from Hospice: Challenges and Solutions

Insurers, including Medicare, fund hospice care only if patients are expected to die within six months. Therefore, hospices regularly reassess this criterion. If a patient improves, they may face discharge, which can pose difficulties, especially if quick replacements for hospice-provided resources are needed.

To secure care, patients need to be informed of their diagnosis. For illnesses where prognosis uncertainty exists, discharge is more common. Therefore, selecting highly rated nonprofit hospices is prudent, as for-profit agencies discharge more frequently.

Reacting to a Discharge

If discharged, understanding your rights is essential. Gather evidence of care needs to support appeals against discharge decisions and keep your primary doctor informed as they lack the hospice’s financial incentives and may assist.

Appeals must be swift, usually within a few hours of receiving notice. Reenrollment in hospice is an option when a patient’s health declines, with both new and previous agencies being viable options.

Presently, Mike continues to relish life. He remains optimistic knowing that when the time comes, compassionate hospice care is available.

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