Hospice Eligibility
Guidelines in determining patient eligibility under the hospice benefit are helpful by identifying those persons that may have a life expectancy of approximately six months or less.
- Coverage of hospice care depends on a physician’s certification that a person’s life expectancy is six months or less if the illness runs its normal course. Recognizing that determination of life expectancy during the course of a terminal illness is difficult, there are guidelines published by the National Hospice and Palliative Care Organization that provide a reasonable approach to the determination of life expectancy based on research.
- If a patient meets the medical criteria, they are, by definition, eligible to receive hospice services. Some patients may not meet the criteria but may still be eligible for hospice care because of other co-morbidities or a decline in their functional status. It is the physician’s clinical judgment regarding the normal course of the individual’s illness that determines a prognosis of six months or less.
- A few indicators that might warrant a hospice evaluation or phone call to the patient’s primary care physician are:
- frequent hospitalizations or ER visits within the last 6 months
- Multiple falls over the last few months
- Unintential weight loss or clothes fitting looserÂ
- Shortness of breath while walking short distances or while resting
- Being told by a physician that treatment for current illness is no longer effective