What does it mean to “graduate” from hospice care?

March 16, 2017 11:34 am

How do you “graduate” from hospice? It’s a fair question. It’s not as if it is an academic accomplishment or a career enhancement which is most commonly associated with this word. Yet, not unlike these transitions, “graduating” from hospice is a significant change and marker along a path.

When someone enters hospice, the expectation is that he/she is in the last stage of life. Often this is the case; however, approximately 20% of patients nationally graduate from this chapter.

Kathy Stockburger talks about her experience with Good Sam Hospice.

Kathy Stockburger’s father was in hospice care for several months before he graduated. She explained that the graduation was meaningful in a number of ways. “It was unexpected,” she explained, “and joyous because we knew we had him around for a bit longer. It was an unintended result of the nurturing care he received from Good Samaritan Hospice.”

Patients are admitted to hospice care when they are not expected to live more than six months. Occasionally while in hospice care, a patient’s condition will improve. This can happen for a variety of reasons, including expert pain/symptom management and a holistic approach to care. When a patient no longer meets Medicare eligibility criteria, he/she graduates from hospice. If care is needed in the future, it is readily available. Medicare does not limit the number of times a patient enters and exits hospice.

“There is a bit of a roller-coaster feeling when one’s parent or loved one graduates from a program which you think at the outset is final,” continued Kathy. “As people who have gone through this journey know, the shift into acceptance that your loved one’s time is limited, even if not exactly defined, necessitates an adjustment to that reality. Likewise, the good news that Dad graduated also took an adjustment to realize that we can’t always predict the trajectory. On a truly positive note, we didn’t anticipate this benefit from the graciousness and comfort of hospice care. Dad’s graduation was marked with a truly festive gathering of family and Good Sam folks, including volunteers. They became his friends, not simply his caregivers.”

Typically, after a patient/family graduates, the hospice team will check in periodically to ensure the patient continues to do well. Should there be further decline, the hospice team reassesses for eligibility and, if appropriate, provides the full plan of care again if desired.

“Once graduated, neither Dad nor the family was forgotten,” Kathy said. “Heartfelt concern and interest does not end at graduation or at the closing of this life under Good Sam care. When Dad re-entered hospice care, somehow we knew this would probably be the last journey together, yet we all felt comfortable, as if we were coming home.”

In most cases, hospice is readily welcomed back when the time approaches because the patient and family are now fully aware of the benefits and are grateful for the additional support. While it may be a difficult time, hospice helps ease the burden and strives to affirm life, even in the midst of illness and grief. The shared journey is often one of deep meaning for patients, families, friends and the hospice team.

“Dad continued to decline physically, yet at 95 was still mentally sharp,” Kathy remembers. “Our hospice staff and volunteers engaged with Dad, fully recognizing he still had lots to say. Some days he would want the nursing home staff, where he spent the last five months of his life, to do his ‘sprucing up’ so he could save his Good Sam visit time for discussing weightier matters…..or just be with a friend. Good Sam was there for me, my mother, and the rest of our large family. In a deep sense, we all travelled together even though just one of us was the ‘patient.’”

So, as with traditional graduations, the age-old question, “What do you hope to do after graduation?” applies here as well. To hospice patients and families, the answer likely comes with true direction. When time is limited, perspective changes and hospice helps patients and families focus on what matters most to them.

If you or a loved one is dealing with serious illness, it’s important to talk with someone about whether hospice is an appropriate option for your family. If you have questions, give us a call.



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