I appealed care situation, but was turned down. I am appealing it for the second time, any suggestion on how to handle the appeal system?

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.

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?

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.

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

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.

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?

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.

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.

bumping up