Yes, people can actually graduate from hospice. Most other hospice’s call it “being discharged”, but I always try to put a positive spin on things. The reason why I decided to write about this topic is that some patients and families come into hospice “kicking and screaming” (figuratively speaking) because they aren’t sure this is what they want, then when they graduate hospice they graduate “kicking and screaming” because they experienced the comprehensive care of hospice and don’t want it to end. So how does one “graduate” from hospice? It usually occurs with non-cancer diagnosis such as End Stage COPD, End Stage CHF and End Stage Dementia. It is much more challenging to predict prognosis with these diagnosis than with cancer. As long as two physicians feel that the patient has less than 6 months, if the disease were to run its normal course, then patients are eligible for hospice. Once they start hospice they have nursing supervision in addition to the home health aides, social worker, chaplain, volunteers, massage, heart touch therapy and physician visits. With close follow up by the team two things happen. We can symptom manage better and sooner (since we are in the home all the time) rather than the patient waiting until the symptom gets really bad and going to the ED, and we can better assess compliance. For example, I have a 72 y/o male with End Stage CHF who was spending 1 week in the hospital, 2-3 weeks out, 1 week in, 2-3 weeks out etc etc. This went on for months before we had a Goals of Care conference with the patient in the hospital and he agreed to hospice care. His cardiologist was baffled as to why he kept coming back when he was “optimized on his diuretics.” The only way he could explain this phenomena was that the patient must not be absorbing the Lasix in his GI tract. During my first home visit, I reviewed his medications, guess what, NO LASIX in the home and no where to be found. It turns out that he had not been taking his medication and didn’t even have Lasix in the house!!!! I ordered Lasix and it has now been 3 months without an admission! This is probably one of the reasons that a new study showed that patients on hospice lived an average of 29 days longer than patients with the same diagnosis not on hospice (The link is below). This is also a common occurrence with End Stage Dementia patients as many patients plateau for an unknown period of time at any stage of the illness (prior to actively dying). If the patients don’t show decline over several months, then any hospice has the obligation to “graduate” a patient if the doctor feels the prognosis has changed. To be honest, this is probably the hardest part of my job, as I’ve seen people who are up, active and talking with their families, die a few days later and one patient with End Stage Dementia I graduated (I’m still following as the attending), over a year ago, is cachectic, contracted, non-verbal, minimally conscious and unable to follow commands but continues to live despite being on hospice for at least two years prior to graduation. Many times I scratch my head but what many patients tell me rings true, “Physicians are not God.” Contrary to popular belief Hospice is not a death sentence and I don’t think I’ve met a patient (or family) that was happy they (or their loved one) was “Graduating” from Hospice.