Hospice Care Criteria

Doctor holding patient's hand

Nobody likes to contemplate the need for hospice care because it’s never easy to face the loss of a loved one. It’s a decision that usually needs to be made while dealing with strong emotions such as sadness, anger, and grief. However, hospice care can be comforting as well. Both for the patient and the family. Hospice care criteria is different from palliative care in that palliative care can begin at the time of diagnosis. Hospice care, on the other hand, begins once treatment is stopped and it becomes apparent that a person will not survive their illness. Both hold the comfort of the patient in high regard, but hospice is where end-of-life comfort care becomes a top priority.

When is it time to consider hospice care as an option?

People become eligible for hospice when a doctor determines they have a terminal illness with a prognosis of six months or less if the disease runs its normal course. A doctor will usually recommend hospice services based on the following three situations:

  1. The patient’s condition stops improving, and they fail to thrive. Usually, at this point, they have progressed into end-stage disease.
  2. If one’s goals change and they decide that they aren’t feeling better and would rather not be in a hospital setting. Or, they feel anxious about dying and want extra supportive care.
  3. Any acute health event, such as a heart attack or stroke, may require immediate end-of-life care.

During hospice, the goals of treatment change. You are no longer treating to cure a disease, you are treating to keep the patient as relaxed and pain-free as possible. Whether patients are suffering from a terminal illness or simply old age, the goals are the same. To ease the process of dying and make it as comfortable for the patient and the family as possible.

How do patients qualify for hospice care?

First, a medical professional must refer a patient for hospice care. Then a hospice nurse will perform an assessment of the patient’s health. During this assessment, the hospice nurse will look for certain hospice care criteria, such as:

  • Daytime sleeping
  • Increased cognitive impairment or confusion
  • Weight loss of 10% in the last 3 – 6 months
  • Incontinence
  • Disease progression in spite of treatment
  • Not performing daily activities
  • Increased hospital stays or visits to the ER
  • Pain and suffering

Once the assessment is complete, it’s reviewed by a hospice team, which is responsible for making the final recommendation that a patient will qualify for hospice care. However, in most medical facilities, it is the medical director that makes the final decision.

What is the hospice care criteria for Medicare?

Hospice is usually covered under the Medicare Hospice Benefit for patients that are eligible for Medicare Part A – Hospital Insurance. A hospice benefit is also available to those that qualify for Medicaid as well. In order to confirm hospice eligibility from Medicare, both a hospice doctor and your regular doctor must certify that the patient is terminally ill with a life expectancy of six months or less if the disease runs its normal course.

It’s important to note that when you agree to hospice care, you forgo any care meant to cure your illness. The patient or their power of attorney will be required to sign a statement choosing hospice care over other Medicare benefits used to treat the patient. Medicare coverage for hospice care includes anything needed for pain relief, nursing and social services, drugs for pain management, durable medical equipment, homemaker services, and other things such as spiritual and grief counseling for the patient and their family.

Hospice Is Difficult but Often Comforting

Once you get through making the hard decision, patients always benefit from end-of-life care. Hospice teams are very experienced in making a custom plan of care for their patients. Whether you decide to use an inpatient facility or do home hospice, the family and the hospice team work closely to provide the best services to benefit the patient. Hospice will make a very difficult time easier to manage for all involved.