Understanding when a loved one or you may be eligible for hospice care is a crucial step in ensuring they receive comfort and live out their remaining days with dignity. To help you make this decision, there are some eligibility requirements set out by law that healthcare professionals must adhere to.
General Hospice Eligibility Requirements
Hospice eligibility will rely on a combination of symptoms and criteria like the following:
- A terminal illness diagnosis with a prognosis of six months or less
- Significant weight loss (more than a 10% loss of body weight within a period of six months)
- Frequent hospitalizations within the past six months
- Increasing fatigue that is affecting the patient’s ability to carry out daily functions
- Declining cognitive and functional abilities with a rating of 50-60% on the Palliative Performance Scale (PPS) or dependence on three of the six Activities of Daily Living (ADLs)
- Comorbidities that are complicating the patient’s health
- Falling with injuries
- Declined tolerance for physical activity
A patient may qualify for hospice care if they meet two or more of the above criteria.
Disease-Specific Requirements
Certain illnesses have their own eligibility requirements, like:
- ALS (Amyotrophic Lateral Sclerosis). ALS patients who have lost the ability to swallow or breathe properly will qualify for hospice.
- Alzheimer’s and Dementia. Patients with alzheimers and dementia who experience a sharp cognitive decline, have difficulty swallowing, or have been diagnosed with sepsis, will be eligible for hospice. Patients who cannot carry out at least two Activities of Daily Living (ADLs) or speak will also qualify for hospice.
- Heart Disease. Because heart disease exhibits so many different symptoms, things like shortness of breath, chest pain, functional decline of cognitive abilities, and a poor response to diuretics will qualify patients for hospice.
- Neurological Conditions. Patients suffering from diseases like MS, ALS, Huntington’s disease, and Parkinson’s will be ready to enter hospice when they show limited mobility, increased pain, and functional impairments.
- Oncology. Cancer patients who are no longer receiving curative treatments and are spending more than 50% of their waking hours in bed are eligible for hospice.
