Hospice Eligibility Criteria
Hospice Eligibility Criteria
Wednesday May 12, 2021
Transitioning to end-of-life care is not always an easy decision to make, but can provide immense benefits to both the patient and their loved ones. Focusing on maintaining the patient’s quality of life and providing psychosocial support for both patients and their caregivers, hospice works to help reduce the stress of living with a life-limiting illness. Importantly, families who choose to engage hospice often report higher patient satisfaction then those who forego care. Hospice satisfaction also increases over time, so it is worthwhile to consider engaging a hospice provider sooner rather than later when faced with an end stage diagnosis.
Hospice is most often provided wherever the patient calls home, including in senior care communities, although in-patient facilities are available as well. Home-based care is often the preferred choice as it lets patients remain in comforting, familiar surroundings. Family or friends who are caregivers receive the support of a team of Hospice professionals who visit on a regular as-needed basis. Care is completely personalized, so visits are scheduled according to the patient’s unique needs – which may change over time.
This is undeniably a difficult transition in life, but having a qualified hospice program walk alongside you can help relieve some of the stress and uncertainty. If hospice care sounds like the right choice for your loved one, you may now be wondering what are the hospice eligibility criteria?
Hospice eligibility guidelines
For a patient to receive hospice care, there are a number of hospice eligibility guidelines that providers consider. To begin with, a physician must certify that a patient’s life expectancy is six months or less. However, know that recertification is allowed, so hospice care can continue longer than six months if needed.
Certain diagnoses make a patient eligible for hospice care. These include, but are not limited to, cancer, heart disease, pulmonary disease, renal disease, dementia, and stroke.
Hospice criteria also requires that all curative treatments must be stopped, but treatments focused on patient comfort can 
continue. This is a hard step for many to take and patient wishes need to align with physician recommendations. If a patient is not ready to stop treatments, palliative care, which provides comfort care alongside curative treatments, can provide the extra support they need.
Physicians will also consider the following about the patient’s health status when making a hospice recommendation:
- Frequent hospitalizations
- Frequent/recent falls
- Recent infections
- Weight loss
- Decrease in appetite/food intake
- Increased weakness/fatigue
- Skin breakdown/wounds
- Change in cognitive abilities
- Requiring assistance with Activities of Daily Living (ADLs) such as eating, bathing, dressing, toileting, transferring/walking, and continence
Know that you do not need to wait for a physician to make a recommendation or referral for hospice care. If you feel that this is the right direction for your loved one, you can request the service yourself – either by asking for a referral from your doctor or by contacting your chosen hospice service directly.
Hospice benefits
If your loved one meets the hospice eligibility requirements, hospice care offers a number of benefits for both patients and their loved ones.
- Focus on patient quality of life and comfort. Hospice is always person-centered, meaning that the patient’s wishes and needs always come first when providing care. A hospice team, consisting of nurses, aides, social workers, chaplains and volunteers, all work together to make sure that patients are holistically cared for – mind, body and spirit.
- Pain management. Hospice nurses are specially trained in pain management and can make sure that your loved one is comfortable by administering pain medication and adjusting doses as needed. They can also offer support and guidance for non-medicated pain management techniques as well.
- Around-the-clock support. No matter what time or day it is, hospice patients and their family members can find comfort in knowing that they will be supported whenever help is needed. Hospice programs have nurses on call 24/7 to provide assistance or answer questions when they arise.
- Spiritual counseling. Many hospices have chaplains on staff to offer support and counseling to both patients and their families. Like the other professionals on a hospice team, hospice chaplains are specially trained to meet the needs of patients at the end of life. Many patients, some who were never formerly spiritual or religious, find this service extremely comforting.
- Caregiver guidance and respite. Recognizing that family caregivers often need breaks to care for themselves, hospice programs can provide help to cover caregiving duties for an extended period of time.
- Covered by Medicare and most health insurances. Those who are concerned about the cost of hospice care should rest assured knowing that services are covered under Medicare and most private health insurances.
- Bereavement support. Grief counseling and support is available as soon as hospice care begins and is offered for a year after the patient’s passing. Many hospice programs, such as Abramson Hospice, also offer support groups that give caregivers and family members the opportunity to meet others who are grieving the loss of a loved one.
Deciding to move forward with hospice care is a very difficult and emotional step to take. However, knowing that your loved one is comfortable and supported can bring great peace overall. If you are interested in learning more about hospice eligibility criteria, and how Abramson Hospice can partner with your family, please call 215.371.1393.
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