Live discharges of patients in hospice home settings-Relief or grief: A narrative study

Live discharges of patients in hospice home settings-Relief or grief: A narrative study
The American Journal of Hospice & Palliative Care; by Jacek T Soroka, Amanda L Paulson-Blom, Alla Blotsky, Jennifer L Derrick, Margaret T Mudroch; 10/25
Approximately 20% of hospice patients in the US are discharged alive, often due to Medicare regulations. One of the caregivers described discharge as distressing and poorly coordinated; the other reported a positive experience shaped by prior knowledge and financial resources. Both emphasized the importance of clear communication, care planning (eg, to avoid loss of durable medical equipment), and interdisciplinary support. Live hospice discharge can cause emotional and practical disruption, especially when not accompanied by a care transition plan or access to durable medical equipment. This study highlights the need for team-based communication, sensitivity in language, and continued support. 
Assistant Editor's note: Hospice patients and loved ones can experience immense ambivalence when there is discussion of live discharge. Usually, these patients have been with hospice for many months or even years. Perhaps the discharge is viewed as good news-even GREAT news(!) that the patient has "graduated" from hospice. Maybe loved ones will throw a graduation party(!) as it means that the patient is no longer terminally ill (as defined by hospice regulations). On the other hand, some patients/loved ones can become very distraught, wondering how they will get along without having a nurse to call in the middle of the night, without their beloved aide who brightens their day with TLC, and without the support and guidance of their social worker and chaplain. Best practices dictate that hospices be proactive in discharge planning when long length-of-stay patients begin to stabilize. There should be frequent and ongoing discussions with the patient/loved ones about the potential for live discharge; it should never come as a surprise. Discharge planning needs to include: how the patient will get their DME/medical supplies/medications, who the loved one can call in the case of a medical crisis, who can provide tangible support and spiritual guidance (if desired), and can palliative care ease the transition once hospice has discharged?