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Hospice Eligibility

Requirements

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.

  • Cancer

  • Congestive Heart Failure / Cardiopulmonary Disease

  • Dementia

  • Cerebral Vascular Accident (CVA) / Stroke

  • COPD / Cardiopulmonary Disease

  • Liver Disease

  • AIDS

  • Neurological Conditions (non-Alzheimer’s dementia, Parkinson’s disease, Multiple Sclerosis, ALS, and Huntington’s disease)

  • Renal Disease

Financial Requirements For Hospice Are:

 

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.

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If you have any doubt about whether the requirements for hospice care have been met, please contact us using the contact form!

Patient and Nurse

Palliative Eligibility
Requirements

Palliative Eligibility

In order to begin palliative care, patients must meet the palliative eligibility requirements established by the U.S. Centers for Medicare & Medicaid Services. While no specific number of symptoms is required when qualifying for palliative care, these guidelines can help determine if a patient’s condition is, or will soon be, appropriate for palliative care.

Palliative Eligibility Requirements:

This is one of the most common palliative care questions. Palliative care is appropriate for any illness that causes long-term pain and discomfort and/or for a chronic condition that causes periodic symptoms. Some examples of common illnesses for which people seek palliative treatment include:

  • Cancer

  • Heart Disease/CHF

  • Respiratory Disease/COPD

  • Renal Disease/Failure

  • HIV/AIDS

  • Chronic Liver Disease

  • Multiple Sclerosis (MS)

  • Alzheimer’s Disease

  • Stroke (CVA)

  • Amyotrophic Lateral Sclerosis (ALS) 

What Types Of Symptoms Is Palliative Care Appropriate For? 

  • Some examples of common symptoms for which people seek palliative treatment include:

  • Shortness of breath

  • Nausea/vomiting

  • Diarrhea

  • Constipation

  • Loss of appetite

  • Fatigue

  • Depression

  • Delirium

  • Difficulty sleeping

  • Anxiety

  • Emotional and/or spiritual distress

Financial Requirements For Palliative Are:

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If you have any doubt about whether the requirements for hospice care have been met, please contact us using the contact form!

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