Increasing Number of People Discharged From Hospices After Exceeding Physician Life Expectancy Predictions

The Washington Post on Tuesday examined how "entering a hospice doesn't invariably mean leaving in a hearse" as more patients are being discharged from hospices alive. An estimated 13% of 900,000 hospice patients nationwide are discharged alive. Many have exceeded their doctor's predictions that they would not live past six months -- a requirement to receive care from federally funded hospice facilities. Those who outlive six months can have their stay extended an additional six months with a physician's certification that they are expected to die within that timeframe. If they outlive the next six months, they are discharged as "extended prognosis" cases. Joanne Lynn, a palliative care expert at Rand, said that at the advent of the hospice movement in the 1980s, most patients were younger -- in their fifties and sixties -- and had advanced cancer, which kills faster and more predictably. Today, many hospice patients are elderly with chronic conditions, such as heart failure, dementia or lung disease, for which the date of death is harder to predict. She said, "We need to ask our doctors -- and our doctors need to answer -- questions such as, 'What's the shortest and longest time you think I have?' [or], 'How is it likely to happen? Will I have a lot of warning or is it likely to sneak up on me?'" (Boodman, Washington Post, 10/3).