Eligibility and Statistics

To be deemed eligible for what insurance company’s call the “hospice benefit,” a hospice medical director must certify the patient’s life expectancy to be 6 MONTHS OR LESS.

One very notable example of how the length of hospice care can vary from patient to patient is that of former President Jimmy Carter and his wife of 77 years, former First Lady Rosalynn Carter. Jimmy Carter celebrated his 99th birthday on Oct. 1, 2023, seven months after he entered a Georgia hospice,” whereas Rosalynn Carter passed away Nov. 19, 2023, at the age of 96, just two days after entering hospice. “The former president Jimmy Carter, passed away December 29, 2024 at the age of 100, 22 months after entering home hospice care.

What explains these discrepancies among life spans of hospice patients? For starters, even stage 4 cancers can be more aggressive in some people than others. And people with other hospice diagnoses such as advanced Alzheimer’s dementia, class 3 or 4 heart failure, end-stage lung disease, and ALS, have varying rates of decline.

The Power of TLC

Often, an acute event leads to a sharp decline in a person who has one or more hospice diagnoses. A common example: a fall leads to a hip fracture and surgery, which then leads to a bad pneumonia, urine infection, or Covid. The patient – who isn’t recovering and even appears to be dying – is referred to a hospice.

But then, sometimes because of the TLC that “the hospice benefit” offers, the person stabilizes, starts eating more, maybe even starts getting up and moving around again. Two, four, six months pass; the person is still alive and even enjoying this new lease on life.

The Re-certification Process

Every two months, a hospice medical director has to re-certify that the patient’s life expectancy remains at six months or less.

Dishonest re-certification is held as fraud, with severe penalties involved. Often, re-certification is an obvious decision: the terminal condition is still present, and the usual course of the condition means less than six months’ life expectancy.

By contrast, when wh the patient recovers so well that the physician can no longer attest to the six-months-or-less life expectancy, the person “graduates” from hospice (with a “safe discharge plan” for continued care in hand).

By its very nature, “the usual course” of a disease doesn’t apply to everyone. It is based on statistical averages, which means some people will live longer than average and other people, shorter than average.

How Much Does Hospice Cost?

Once hospice eligibility has been determined, the care is 100% FREE for the patient. Typically, hospice benefits are paid for by Medicare. Rarely, in cases with younger patients, a private insurance company covers the costs.

What Is Hospice Care?

First, I’d like to make clear what hospice care is not: namely, it is not 24/7 care.

Now, here’s a list of what hospice is:

• 1. 24/7 access to an on-call MD or NP (nurse practitioner), who can prescribe or adjust medications – not only for the patient’s comfort but also for secondary conditions like a urine infection or a pneumonia.
• 2. Regular home visits by a nurse to evaluate and monitor the patient and to educate caregivers on medication administration and other critical aspects of care. These visits are usually weekly, rarely biweekly, and sometimes daily, as needed.
• 3. Evaluation by a social worker, to review relevant community resources and to provide counseling.
• 4. Access to an interfaith chaplain, if desired, and highly recommended. Their wisdom and kindness does not rest on any formal religious pillar. They can help tremendously in sorting out things such as funeral arrangements and practices for specific religions and traditions, as an example.
• 5. Medical equipment such as a hospital bed, bedside commode, wheelchair, walker, and portable oxygen.
• 6. Regular visits by a CNA (certified nursing assistant), for care such as bathing and wound dressing changes.

Hospice provides an alternative to spending the remaining days of one’s life going in and out of ERs, hospitals, and ICUs. And, it is, of course, the patient’s choice whether or not to keep seeking maximal curative-oriented treatment which can include challenging side effects such as nausea and vomiting, nerve pain, and others. Hospice care creates the opportunity and urgency to say goodbyes and even repair damaged relationships. Even in the worst-case hospice scenario, hospice can lead to a comfortable and, believe it or not, even a happy ending of life – in a home setting with family at the bedside. I even had a patient once tell me “It’s too bad we have to wait until we’re dying to get all that comes with this hospice benefit.”

What that patient and I both realize, the message that I’m trying to send here is this: Hospice is about Life, it’s about fostering well being even under the most challenging circumstances. Where there is Hospice, there is Love.