Eligibility For Hospice Care

To begin hospice care, patients must meet the hospice eligibility requirements established by the U.S. Centers for Medicare & Medicaid Services. While there are no specific number of symptoms that are required when qualifying for hospice, these general guidelines may help determine if a patient’s condition is, or will soon be, an appropriate fit for hospice care.

Eligibility For Hospice Care

  • The patient has been diagnosed with a life-limiting condition with a prognosis of six months or less if their disease runs its normal course
  • Frequent hospitalizations in the past six months
  • Progressive weight loss (taking into consideration edema weight)
  • Increasing weakness, fatigue, and somnolence
  • A change in cognitive and functional abilities
  • Compromised Activities of Daily Living (ADLs) such as eating, bathing, dressing, toileting, transferring/walking, and continence
  • Deteriorating mental abilities
  • Skin breakdown
  • The specific decline in condition

Eligibility For Hospice Care

There are also specific hospice eligibility criteria to consider based on the patient’s primary diagnosis. Choosing from the list of diseases below will let you read the applicable requirements for hospice care.

  • AIDS
  • Cancer
  • Cerebral Vascular Accident (CVA) / Stroke
  • COPD / Cardiopulmonary Disease
  • Dementia
  • Liver Disease
  • Neurological Conditions (non-Alzheimer’s dementia, Parkinson’s disease, Multiple Sclerosis, ALS, and Huntington’s disease)
  • Renal Disease

Financial requirements for hospice are:

  • Medicaid hospice eligibility criteria
  • Medicare hospice eligibility criteria
  • Private insurance hospice eligibility criteria

Please note:

Co-morbidities, the presence of two or more chronic diseases or conditions at the same time, are also a factor to consider in qualifying for hospice.

If you have any doubts about whether you or your loved one have met the requirements for hospice care, please contact us.

Who can contact or ask for hospice services?

  • Patients
  • Members of the family or acquaintances
  • Physicians or medical practitioners

Contact Shining Light Hospice Care as soon as possible. If you’re not sure whether hospice is the right choice, we can help. Families are provided with the resources they need to realize what to anticipate as the conditions of their loved one’s advance.

What is to be expected?

  • A qualified and professional Hospice Admissions Representative can schedule a confidential meeting for you and your relatives.
  • Each patient is assessed independently to evaluate their prognosis and whether their therapeutic priorities are compatible with what hospice offers.
  • A doctor’s referral is received before admission, and the evaluation of the hospice should be completed; federal or state laws require hospice eligibility to be proven. Centers for Medicare and Medicaid (CMS) recommends doctors to refer ASAP the patients with life-limiting diseases, noting:
  • A prognosis doesn’t need to be set in stone because specific end-stage scenarios include unforeseeable paths.
  • Patients may feel better at first
  • Hospice can, on occasion, last longer than six months

When a doctor has confirmed that a life expectancy is six months or fewer, you might be considered for hospice. You are always entitled to change your mind and go back to curative therapy should you believe it’s the best choice for you or your loved one. You can also be referred to the hospital for other forms of care, as long as the treatment is not linked to the condition of the hospice care, and the therapy includes enhancing the quality of life.

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