Hospice Eligibility Guidelines

When Should a Patient be Referred to Hospice?

Patients and families can benefit most from hospice care when they seek support earlier rather than in a crisis. The best way to determine if you or a loved one can be helped with 24/7 care at home by Maxcare Hospice is to talk to your doctor. When your doctor discusses hospice care with you, he or she is simply presenting an option for comfort, which in many cases may actually lengthen life by increasing the quality of the time remaining. It’s important you talk openly with your doctor and loved ones and share the same goals for maintaining quality of life.

Who Qualifies for Hospice in California

• Two physicians certify a life expectancy of about six months or less if the illness follows its usual path.
• You (or your representative) elect the hospice benefit rather than curative treatment for the terminal diagnosis.
• Your needs align with one of the four hospice levels of care: routine home care, continuous home care, general inpatient care, and inpatient respite care.
• Add a short list of common diagnoses (educational tone):
• Advanced dementia/Alzheimer’s, heart failure, COPD/advanced lung disease, metastatic cancer, stroke, end-stage kidney or liver disease, ALS, Parkinson’s.

To be admitted to the hospice program, a patient must meet the criteria noted on the Eligibility Guidelines. However, the overriding guideline is a simple one: the patient must be certified by a doctor as having a limited life expectancy of six months or less, if the disease follows its natural course. The patient will also have chosen to pursue comfort care rather than aggressive treatment. Please call today to learn more. (714) 844-7777.

What Does Medicare Cover on Hospice

• Medications, medical equipment and supplies related to the terminal diagnosis
• Regular visits from nurses and aides, social work and chaplain support
• 24/7 on-call nursing support
• Grief and bereavement support for the family

Note: Room and board is not covered unless short-term inpatient care is required for symptom management.

Four Levels of Hospice Care

• Routine home care: Day-to-day symptom management at home.
• Continuous home care: Short-term crisis support at home.
• General inpatient care: Short-term symptom control in a contracted facility.
• Inpatient respite care: Short stay in a facility to give caregivers rest.

Signs it Might be Time

• Unplanned hospital or ER visits in the last few months
• Progressive weight loss or poor appetite
• Needing more help with daily activities
• Shortness of breath at rest, uncontrolled pain, distressing symptoms
• Increasing infections or frequent falls

What is The Admission Procedure?

Same day admissions are common and can happen relatively quickly once your doctor writes an order for a hospice evaluation.

When it’s time to consider hospice as an option, the first step is to make an initial request by calling (714) 844-7777. The next step is to request that hospice send a representative to meet with the patient and family/ caregiver. This request may be made by the individual’s physician, the staff at the hospital or you can initiate the call to hospice yourself. There is no cost for this visit and the is no obligation to make a choice immediately.

During the initial call, an admissions nurse will record vital information, discuss your hospice benefit with you and answer all of your questions.

During the initial visit, a team member will thoroughly explain your Explanation of Benefits [EOB]. If the patient’s need is urgent, with a doctor’s order, our admission nurse can provide the physical assessment at the same time as the EOB.

Once the consent forms are signed and if the patient is qualified to receive their hospice benefit, the admission can take place right away. The admitting nurse will assign the care team, order any necessary medications, medical equipment (hospital bed, overbed table, oxygen concentrator, wheel chair etc.,) as well as any necessary incontinent supplies. All at no out-of-pocket cost to the patient/ family.

How Long Will it Take to See Someone?

Most admissions can take place within 24 hours of your initial call, provided your doctor has faxed an order (at your request) for “Hospice Evaluation” to (714) 844-7777. The hospice intake coordinator can assist you with obtaining an order from your doctor at your request. Once admitted, you will hear from the care team to make individual visits at a mutually convenient time.

Who Pays for Hospice care?

Most hospice patients and eligible for Medicare, which covers all aspects of hospice care and services. There is no deductible, although there may be a very small co-payment for prescriptions and for respite care. Medi-Cal offers similar coverage, as do many private pay insurance plans.

What Services Are Included in Hospice?

• Time and services of the care team, including visits to the patient’s location by the hospice physician, nurse, medical social worker, home health aide, chaplain and volunteer.
• Medication for pain relief and/ or symptom management
• Medical equipment and incontinent supplies
• Speech language pathology services
• Dietary counseling
• Short term inpatient care when adequate pain and symptom management at home cannot be achieved
• Sort term respite care [temporary relief in a nursing home setting for “caregiver burnout”]
• Grief counseling for patient and loved ones

Will I Continue to Take Care of the Patient?

The primary caregiver—often a family member, friend, or hired caregiver—receives training
and support from the hospice team, helping the patient stay in the place they consider home.
This is typically their private residence, an assisted living community, a nursing home, or a
board and care home. Staying in a familiar setting allows the patient to feel more at ease and
remain close to loved ones, where they are most comfortable and experience joy.

Who Makes Up The Hospice Care Team?

At Maxcare Hospice, every patient and family receive care from a compassionate, skilled, and
dedicated team. Each member plays a vital role in supporting comfort, dignity, and quality of
life.

Registered Nurse (RN) – Your Clinical Care Leader

Our hospice RN is the team leader and first point of clinical care. The nurse performs the initial
assessment, develops your individualized care plan, and closely monitors symptoms and
comfort levels. They communicate with the hospice physician about any changes, ensuring
timely adjustments to your care.

Licensed Vocational Nurse (LVN) – Day-to-Day Nursing Support

Working under the direction of the RN, the LVN helps with hands-on nursing care—such as
medication administration, wound care, and symptom management—keeping your loved one
as comfortable as possible.

Medical Social Worker (MSW) – Emotional, Social, and Practical Support Our social workers provide counseling and emotional support for patients and families navigating the challenges of serious illness. They also help with community resources, advance care planning, and financial concerns—offering guidance when you need it most.

• Home Health Aide – Personal Care and Comfort. Our aides assist with essential daily activities like bathing, dressing, grooming, and changing linens—ensuring your loved one feels clean, comfortable, and cared for at home.
• Chaplain – Spiritual and Emotional Comfort. Hospice chaplains offer non-denominational spiritual support tailored to your beliefs and values. They’re here to listen, pray (if desired), provide grief support, and help with funeral planning or memorial tributes. Their care extends to both patients and family members.
• Hospice Volunteers – Compassionate Companionship. Specially trained hospice volunteers offer companionship, help with errands, light household tasks, or simply sit and visit. They bring extra warmth and support into your home when you need a friend most. Maxcare Hospice currently as a licensed pet therapist, haircare provider, massage therapist and a lovely volunteer who provides live therapeutic music for your comfort and enjoyment.
• Medical Director – Expert Oversight for Your Care. Our board-certified hospice physician oversees your entire care plan, advises the team, and works closely with your doctors to ensure the best medical decisions for comfort-focused care. Need More Information or Ready to Get Help?

We’re here to answer your questions 24/7. Call us today to learn how we can help bring
comfort and support to your family.

Here are some indicators that your family will benefit from hospice:

• Your family is feeling isolated due to caregiving demands
• You or members of your family appear to need more emotional support to cope with the sadness of the situation.
• You are overwhelmed by the myriad physical financial, emotional and spiritual concerns arising because of the illness.
• You or your caregivers and physically and/or emotionally exhausted from caring for you or a loved one.

Dispelling Hospice Myths:

Myth: Hospice is a place.
Fact: Hospice care takes place wherever the patient calls home, including skilled nursing and assisted living facilities.

Myth: Hospice is only for patients who have given up hope and are close to death.
Fact: Hospice is about living as fully as possible. In fact, patients and families receive the greatest benefit when hospice is started early.

Myth: Since hospice care is only available for 6 months, delay enrollment as long as possible
Fact: Hospice patients can stay on hospice care for as long as medically necessary while the disease follows its natural course.

Myth: Hospice gives the patient so much medicine that the patient is out of touch, sleeps too much and becomes addicted to the pain medication.
Fact: The primary goal of hospice care is to make the patient as comfortable, pain free and alert as possible.

Myth: Hospice stops feeding patients and they become dehydrated and starve to death.
Fact: Hospice encourages patients to eat and drink as much as and only what they want. It is natural for some patients not to feel hunger or thirst when they reach the end-of-life decline.

FAQs

• Do I need to wait for my doctor to bring up hospice?
  No. You or your family can contact Maxcare Hospice directly. Our team coordinates with your physician to confirm eligibility and obtain the required certifications.
• What if my loved one lives longer than six months?
  Hospice can continue as long as eligibility is recertified at required intervals. Many patients receive support beyond six months.
• What are the four levels of hospice care?
  Routine home care, continuous home care, general inpatient care, and inpatient respite care. These levels allow the team to match support to your needs.
• Does insurance cover hospice?
  Medicare, Medi-Cal, and most private plans cover hospice when eligibility requirements are met. Maxcare Hospice verifies benefits and explains coverage.
• How fast can hospice start?
  Often the same day after eligibility is confirmed. An on-call nurse is available 24 hours a day for urgent needs.