Hospice Eligibility Criteria.
In order to begin hospice care, patients must meet the hospice eligibility requirements established by the U.S. Centers for Medicare & Medicaid Services. While no specific number of symptoms is required when qualifying for hospice, these guidelines can help determine if a patient’s condition is or will soon be appropriate for hospice care.
Hospice eligibility requirements:
- 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.
- Recurrent Infections.
- Skin breakdown.
- Specific decline in condition.
Disease-specific hospice eligibility criteria.
There are also specific hospice eligibility criteria to consider based on the patient’s primary diagnosis.
Disease-specific requirements for hospice care:
- Cerebral Vascular Accident (CVA) / Stroke
- Congestive Heart Failure / Cardiopulmonary Disease
- COPD / Cardiopulmonary Disease
- 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
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 doubt about whether the requirements for hospice care have been met, please contact us at 1-888-564-3405 for a hospice consultation.