Failure to Decline in Hospice – The Good and The Ugly

Table of Contents

If your loved one is facing a discharge from hospice due to failure to decline, it’s crucial to comprehend the situation. This discharge indicates that the healthcare team believes your loved one’s condition has stabilized and no longer requires hospice care. While this might be a positive sign, weighing the pros and cons before making decisions is important. Let’s delve into this situation’s positive and negative aspects to help you navigate it effectively.

The Good

Improved Health: A discharge for failure to decline often signifies that your loved one’s health has stabilized or improved. This positive development shows progress in their recovery journey.
Greater Independence: Transitioning out of hospice care allows your loved one to regain independence. They can resume daily activities, contributing to overall well-being and mental health.

The Bad

Patient’s Terminal Status: Discharge for failure to decline doesn’t guarantee the patient isn’t terminal. Sometimes, patients are terminal without acceptable evidence by Medicare. Families can appeal such discharges.
Increased Caregiver Responsibility: Discharge shifts care responsibility to family members or caregivers. This can be challenging without preparation or support.
Potential for Readmission: Discharge doesn’t guarantee continued stability. Setbacks may lead to readmission. Close monitoring and emergency plans are crucial.
Limited Specialized Care Access: Leaving hospice means less access to 24×7 specialized services. Sudden deterioration or new challenges may lack immediate specialized care.
Adjustment Period: Transitioning is demanding emotionally and physically. Adjusting to new routines, environments, and responsibilities takes time.

How to Appeal a Discharge from Hospice Care

If a patient, power of attorney, or family member of the patient does not believe that a discharge from hospice care is appropriate, they may be able to appeal the decision. Here are some steps to take before the last skilled nursing visit:

Contact the hospice provider: The first step is to contact the hospice provider and ask for an explanation of the discharge decision. It may be helpful to have a list of questions prepared in advance.
Request a review: If the hospice provider’s explanation is unsatisfactory, the patient or their representative can request a review of the decision. An independent organization or the hospice provider may conduct this review.
File a complaint: If the review does not result in a satisfactory outcome, the patient or their representative can file a complaint with the state agency that regulates hospice care. This agency will investigate the complaint and may take action if it finds that the hospice provider has violated any regulations or standards.

Conclusion

When facing a discharge from hospice care due to a failure to decline, it’s essential to carefully evaluate both the positive and negative aspects of this situation. On the positive side, it can indicate improved health and greater independence for your loved one. However, the potential negatives include the uncertainty of the patient’s terminal status, increased caregiver responsibility, the risk of readmission, limited access to specialized care, and the challenging adjustment period. If you disagree with the discharge decision, you can appeal by contacting the hospice provider, requesting a review, and filing a complaint with the state agency. These steps can help ensure your loved one’s best interests are considered throughout their hospice care journey.

Resources

Hospice Expedited Determination Process including appealing

What happens when patients are discharged from hospice care?

Race, Ethnicity and Other Risks for Live Discharge among Hospice Patients with Dementia

The Hidden Curriculum Of Hospice: Die Fast, Not Slow

Live discharge from hospice for people living with dementia isn’t “graduating”—It’s getting expelled

Life Discharge Toolkit

The Experience of Being Discharged from Hospice Alive as Perceived by Patients, Their Spouses, and Adult Children

The National Academy of Elder Law Attorneys (NAELA) is dedicated to improving the quality of legal services provided to older adults and people with disabilities

Articles on Advance Directives

Eldercare Locator: a nationwide service that connects older Americans and their caregivers with trustworthy local support resources

Find the Long-Term Care Ombudsman Program in Your State

Patients Voices Matter Foundation – Empowering Patients, Transforming Lives

Independent Patient Advocate – Independent, non-clinical patient advocacy nationwide. Health Navigation, SSDI Application & Appeals, and Whole Health Advocacy. 100% remote. No insurance accepted.

Natural Death With Dignity: Protecting Your Right To Refuse Medical Treatment

Beyond the Living Will: Creating Effective Advance Directives

Make Your Own Medical & Financial Power of Attorney: A Step-By-Step Guide to Making a Power of Attorney

Last things first, just in case… The Practical Guide to Living Wills and Durable Powers of Attorney for Health Care

Death and Dying: A Good Exit Plan

Free Daily Symptom Tracker

Free Caregiver and Dementia Training Videos

CaringInfo – Caregiver support and much more!

The Hospice Care Plan (guide) and The Hospice Care Plan (video series)

Understanding Palliative Care: A Guide to Common Questions and Answers

Bridging the Gap: Palliative Care’s Role in Supporting Rare Disease Patients

Comprehensive Guide to Financial Assistance for Hospice and Palliative Care Patients

Surviving Caregiving with Dignity, Love, and Kindness

Caregivers.com | Simplifying the Search for In-Home Care

Geri-Gadgets – Washable, sensory tools that calm, focus, and connect—at any age, in any setting

Healing Through Grief and Loss: A Christian Journey of Integration and Recovery

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