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My husband has COPD, CORONARY DISEASE GLAUCOMA, PERIPHERAL ARTERY DISEASE, CAROTID ARTERY DISEASE, LUMBAR DISC DISEASE, HYPERTENSION. Has been on Hospice for 2 years, and now they have decided to release him citing he is stable. Our Hospice is a for profit facility and now that he is worse than ever, they have decided to release him based on financial concerns rather welfare of patient.

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Can you document ANY decline since his last re-certification? If so that is what the re-certification would be based on.
What "condition" was the reason he was accepted for Hospice? Was it the COPD? or Coronary disease? If he has been stable with both that would be the reason he is going off Hospice.
You can always contact another Hospice.
The one I/we used was a Not for Profit Hospice but they all..again ALL have to follow Medicare guidelines for continuing or re-certification on Hospice.

I know several people that have had the same thing happen, it is like getting the rug ripped out from under you when they are removed from Hospice. All the help, education and support goes away, all the equipment goes, all the supplies are now your responsibility to have to go get rather than having supplies and medication delivered.
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Reply to Grandma1954
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I would leave glaucoma and degenerative disk disease out of the appeal. Neither of these is life-threatening--and I assume he is still treating his glaucoma because of that. I think throwing in health issues that are not life-threatening may be a red flag that makes it look like you're just listing any possible health problem without regard to how the problems affect his hospice status.
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Reply to caroli1
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I would leave glaucoma and degenerative disk disease out of the appeal. Neither of these is life-threatening--and I assume he is still treating his glaucoma because of that. I think throwing in health issues that are not life-threatening may be a red flag that makes it look like you're just listing any possible health problem without regard to how the problems affect his hospice status.
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Reply to caroli1
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Farfarm, this isn't my area because I'm not from the USA; but from what I've learned here on AgingCare it does seem that the gremlin in your picture is that your husband has received treatment for a series of infections. Normally, as I understand it, active treatment of acute infections would not be considered appropriate in a palliative care or hospice setting. Your attending physician must have done some very fast talking!

But, suppose everyone agrees that hospice is not the right service for him because he wants to continue to receive more than palliative care. Would that make it impossible to provide him with what he needs? If so, how would it?

How is your doctor squaring his aggressive therapeutic approach with his recommendation that your husband should not be discharged from hospice?
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Reply to Countrymouse
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worriedinCali May 6, 2019
i don’t think it’s her husband’s doctor. It’s the hospice doctor and Medicare won’t pay for hospice if the hospice doctor won’t re-certify.
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Just in case you lose your second appeal, I would have a “Plan B” ready.
As someone said, it appears that he no longer qualifies for hospice if he has not passed away in 2 years! 2 years. Yes COPD is a slow progressive disease. You say you’ve had to push the staff to treat infections on hospice as well. And if hospice presents medical records to prove he is not at end of life why would you want him on hospice where you know you will continue to have the battles about treating him when he gets an acute infection?

Plan B is warranted as the decision may not be in your favor.
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Reply to Shane1124
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I know for a fact there are lots of people who have been on Hospice for 2 years or longer..because COPD takes such a long time to finally cause death, and there are so many times he has been close to death, and as long as he continues to diminish he can stay on Hospice...he meets all the criteria...I don’t need on recommendations for putting him in a nursing home, the point is as long as he is diminishing, dying he qualifies, so this is there way of getting out from underneath it all...it is financial...There are lots of instances where this is happening all over...once they stop making a profit, they kick them out....Alzheimer’s and dementia patients are facing the same situation...Hospice gets paid by Medicare...I was just looking for feedback on their repeal system...nothing else thanks anyway
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Reply to farfarm1987
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worriedinCali May 6, 2019
It’s not about profit. If Medicare is paying for this, that’s the problem. It’s likely Medicare deciding they will no longer pay because he’s been on hospice for 2 years, it’s not hospice’s fault.
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Sounds like he needs to be placed in a nursing home. As ACaringDaughter mentioned Hospice is for end of life, not to give medical treatment. I'm surprised they left him on Hospice for 2 years.
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Reply to Caregiverhelp11
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You explain that your hospice is a for-profit facility. Does this mean that they are planning to discharge him, as in "off the premises," so to speak? Discharge him to where?

If it isn't a residential-type hospice, and the discharge means only that this organisation will not be providing palliative care services any more, what do they recommend as the best option for him? Have you discussed with them what happens next?

As for appealing the decision: you would have to demonstrate that your husband does meet the criteria for hospice. With a two year medical history exceeding life expectancy on admission, and no sign of deterioration, this is going to be a challenge. You say that he is worse than ever: do you have medical opinion(s) to back that up?

I just found a very interesting article about "involuntary discharge" which discusses several of the issues but also explains:

"APPEALING AN INVOLUNTARY DISCHARGE
Patients have rights to appeal denials from Medicare, Medical Assistance, the Department of Veterans Affairs, and private insurance companies. Contact the insurance company for information about the appeals process."

So that sort of puts us back to square one: what organisation are you appealing to, exactly?
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Reply to Countrymouse
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farfarm1987 May 4, 2019
It’s a in home hospice...his attending physician feels he still qualifies...they have mentioned to me several times that his pain medicine is very costly...always bringing up costs...and yes COPD is a slow disease,...he has had an infection every month for several months, that have caused lots of back pedaling and yes of course I have medical data including his attending dr..... to back me up...they are trying to pull a fast one on us...they were very difficult when it came to treating the infections...his attending physician prescribed them and they kept being difficult about it...there are so many variables in our situation, it is hard to address them all right now...and I know 2 years is a long time...but I know for a fact there have been plenty of people who have been on Hospice that long or longer...I didn’t know if there were people out there who had suggestion for the repeal process..want to make sure I cover my bases.... thanks so much for your input
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It has been talked about a couple of Xs on forum of Medicare having a "special needs" help. Maybe someone can chime in on this.
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Reply to JoAnn29
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Hospice is intended to comfort end-of-life patients in their last 6 months, when absolutely nothing else can be done. The treatment is designed to soothe and ease someone into passing, not to heal.

View this is as positive.

This is doesn’t mean he won’t get medical care, hospice may not be the appropriate type of care for him now.
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Reply to ACaringDaughter
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bumping up
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