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December 1988

Inaccurate Predictions of Life Expectancy: Dilemmas and Opportunities

Author Affiliations

Seattle Veterans Administration Medical Center Division of Geriatric Medicine and Gerontology Department of Medicine University of Washington Seattle, WA 98108

Arch Intern Med. 1988;148(12):2538. doi:10.1001/archinte.1988.00380120007001

Hospice is a successful model for providing palliative care and psychosocial support to terminally ill patients. Although most patients who receive hospice care have cancer, patients with acquired immunodeficiency syndrome increasingly are taking advantage of these programs. Since 1983, Medicare has provided hospice reimbursement for patients meeting four criteria: (1) life expectancy of six months or less as certified by a physician; (2) unable to benefit from aggressive or curative therapy; (3) able to receive at least 80% of care at home; and (4) availability of an individual who can provide custodial care and serves as a "proxy" decision maker for health care decisions if the patient becomes mentally incapacitated.1

See also p 2540.

Unfortunately, predictions regarding life expectancy are often imprecise, a problem in determining eligibility for hospice care. In this issue of the Archives, Forster and Lynn2 present further evidence of this lack of accurate prognostication

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