Most everyone has heard that in order to qualify for hospice care, the patient must be expected to die within six months. But, just as with everything else health care related, there is a "But" to this requirement, too. Despite what it may sound like, there is no requirement that anyone must die within six months or be terminated from hospice care.

In the United States, people with Medicare (and most other private insurance) can receive hospice care if their doctor believes that they most likely have less than 6 months to live if their illness runs a normal or typical course. While the doctor must, in his or her best judgment, believe that the patient will die within six months, there is no requirement that the patient do so. If the patient lives longer than six months, hospice care can continue. In this case, the doctor and the hospice team will re-certify that the patient is terminally ill and that hospice services are appropriate. There is no end to the hospice benefit under Medicare if the patient continues to meet the "expected within the next 6 months" criteria.

Other than having this "6-month certification" from the doctor, there is only one other requirement to receive hospice services, either at home, in a nursing home, or even in special circumstances in a hospital. If the patient is still actively receiving treatment with the hope of a cure, then hospice is not yet appropriate. Palliative care might be, however.

When treatment options have been exhausted and there is no longer a reasonable expectation of "cure," hospice becomes a very valuable option. Because there is no 6-month time limit patients don't have to worry about using up their hospice care benefit too soon. Even most patients who were not feeling especially sick at the time were ultimately glad that they enrolled in hospice before they became extremely ill. Being enrolled early gave them and their loved ones the opportunity to get to know and trust their hospice team before physical symptoms became severe.

Jake Simmons always joked that he was too tough to kill. He ultimately spent almost three years on hospice, outlasting his doctor's original 6-month prognosis by nearly 30 months. Only the last two months of his life were difficult. While he was on hospice Jake had the opportunity to visit his new grandbaby in Australia, and he was able to finish building a photograhy studio for his wife before his illness robbed his strength. When he broke his ankle about a year before his death, Jake's orthopedic care was no different that it would have been had he never heard of hospice.

Unlike regular Medicare home care, there is no requirement that a Medicare hospice patient be home bound. This means that patients who are terminally ill, but who still feel well enough, can leave the house for any activity they wish. Some hospice patients have even traveled to Europe, or have taken the cruise of their dreams, while enrolled in hospice. The goal of hospice care is to make whatever time the patient has remaining as pleasant and pain-free as possible. Hospice caregivers will encourage their patients to participate in life to the best of their ability for as long as they are able.

Nor is the decision to choose hospice care final. If a new treatment comes along and is recommended by the patient's doctor, the patient can return to regular Medicare at any time and try this option. Later, if the patient wants to return to hospice, all it takes is another "6-month certification" from the doctor. Likewise, if the patient simply stabilizes or improves, he or she can always leave hospice and return to regular Medicare, and later return to hospice care at any time it seems appropriate.

A patient who is terminally ill and receiving hospice care can always receive medical treatment for any illness or condition not related to the terminal diagnosis. Just as for Jake's ankle, Medicare will cover treatment for any condition other than the terminal illness under Part B, just as before.

Patients can leave hospice care at any time for any reason, or even for no particular reason at all, should they choose to do so. Patients who simply decide they don't like hospice or their hospice team, or who for whatever other reason want to return to regular Medicare are welcome to do so. It is not even necessary to tell either Medicare or the hospice team why they want to make the change.

So, the 6-month rule is not something to be overly concerned about if you are considering hospice care. If you believe it would be a good idea, but the doctor hasn't mentioned it, you can raise the question. Some doctors may be reluctant to suggest hospice care, because they feel that they have failed their patient if they do. This is certainly not the case. It's a simple fact that not everything can be cured, and sometimes the only thing medicine has to offer is supportive care. In many ways being able to offer comfort care is a triumph, not a defeat.