Wikis > Who is eligible for hospice care?

As a general guideline, hospice is recommended to a patient with an incurable terminal disease with a life expectancy of six months or less if the disease were to run its normal course.

Although this is the rule by which Medicare defines hospice eligibility, it is not always possible to predict the prognosis whether an individual will live less than six months. Therefore, certain clinical criteria are in place for common hospice diagnoses. Physicians can use these guidelines to assess whether someone is a candidate for hospice referral.

In addition to disease specific criteria, there are also other general guidelines for hospice eligibility. These guidelines are based on the patient’s functional status and physical signs and symptoms which can indicate advanced stages of a disease regardless of the diagnosis except medicare do not allow the admission on hospice with the diagnosis of “debility”.

Even with these guidelines in place, many patients outlive the six-month period on hospice. If this happens, hospice can thoroughly reassess the overall condition of the patient and determine whether there are signs of ongoing clinical decline and patient still has poor prognosis and declining.  They can then recertify the patient to remain on hospice if there is evidence of disease progression. first 2 cerifications are for 90 days each followed by unlimited  60 days, provided the patient continue to decline. 

Sometimes, the disease may stabilize, or the patient’s condition may show evidence of improvement during hospice care. In these situations, hospice will terminate hospice care and the patient can resume their routine health-care which they had prior to the hospice enrollment.

Medically Reviewed by a Doctor on 4/29/2014