Understanding eligibility: Ensuring comprehensive and compassionate care.
Does your patient need hospice? Use our guidelines to determine if your patient needs palliative care or hospice services.
Hospice Eligibility Guidelines
These guidelines, both general and specific to diagnosis, are designed to assist you in determining if a patient is eligible for hospice services. Please note that these guidelines are intended to be a useful resource but should not replace a physician’s clinical discretion.
Who is Eligible for Hospice Care?
When considering hospice care for a patient, it’s important to take into account the following eligibility guidelines:
- Terminal illness with a prognosis of 6 months or less and the patient or family choosing palliative care
- Declining functional status, as measured by a Palliative Performance Scale rating of 50-60% or dependence in 3 out of 6 daily activities
- Altered nutrition, such as a weight loss of more than 10% over the past 4-6 months
- An observed and documented decline in overall clinical condition, including:
- 3 or more hospitalizations or emergency room visits
- Decreased tolerance for physical activity
- A decline in cognitive ability
- The presence of other comorbid conditions
It’s important to keep in mind that these guidelines are meant to be a helpful tool, not a substitute for a physician’s professional judgment.
What is Hospice Care?
Hospice care is a specialized approach to end-of-life care that focuses on providing comfort, dignity, and support to individuals and their families. It addresses not only physical needs but also emotional, social, and spiritual needs holistically and compassionately.
Who Pays for Hospice Care?
Hospice care is typically covered by Medicare, Medicaid, and private insurance, but financial assistance may be available for the uninsured or underinsured. Patients and their families are encouraged to speak with their hospice provider to understand their specific insurance coverage and any available financial assistance options.
Where is Hospice Care Provided?
Hospice care can be provided in various settings, including the patient’s home, nursing homes, assisted living facilities, and hospice centers. The location of care is based on the patient’s needs and preferences, and the goal is to provide comfort and support in the most appropriate and convenient setting.
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