How Does Someone Qualify For Hospice?

How does someone qualify for hospice care?

In any disease trajectory, there are three possible outcomes: stability, improvement, or decline. If the likelihood of decline is high, it may be time for an open and honest discussion about the goals of ongoing care. You may also wonder if your loved one qualifies for hospice.

Understanding the rate of decline requires families to consider some very tough, but necessary questions:

• What are the signs, symptoms, complications, and expected scenarios the patient will experience?
• Is that something they would personally like to go through?
• Is it something the patient themselves would want to see a loved one go through?

It’s also important to consider that hospice does not have to be a permanent choice. It is an elective benefit that can be revoked at any time. But whatever the choice, it starts with a clear and frank discussion between the patients, families, and healthcare providers.

Criteria to Qualify for Hospice

In order to qualify for hospice, as per the Centers for Medicare & Medicaid Services (CMS), a patient’s health is judged according to five criteria:

Poor Candidate for Treatment

Hospice care is palliative. Its goal is to ease symptoms, not address their underlying causes. A patient may qualify for hospice if their quality of life would not be improved by aggressive treatment such as hospitalization, surgery, chemotherapy, radiation, or hemodialysis.

Nutritional Status

To determine a patient’s nutritional status, poor appetite and weight loss are typically the first major indicators. Factors considered in a nutritional assessment include how the patient has been eating, if they have experienced significant weight loss over the last six months, and if they’ve lost 10% or more of their body weight. Other signs of significant weight loss include:

Ill-fitting clothing

Decrease in skin elasticity: skin should normally form a tent-like shape when pulled lightly

Increase in skin folds

Difficulty swallowing: this is usually identified as coughing when drinking and/or eating

Functional Status

Functional status takes the patient’s overall energy levels into account, focusing on whether the patient is significantly weaker than they were six months ago. Signs may include:

Reduced ability to walk

Development of pressure sores

Increase sleepiness

Lower blood pressure

Changes in mental status and behavior

Not every patient who requires assistance for these issues qualifies for hospice. But if they now require noticeably more help than before, they may qualify.

Normal Course of the Disease

Assessing disease progression takes the recent past and immediate future into account. Looking back over the last 6-12 months, has there been a decline in the patient’s health? Looking ahead six months from now, based on the clinical judgment of the physician, is the disease likely to result in limited life expectancy? If so, they are likely a candidate.

Disease Specific Criteria

CMS has issued guidelines for specific diseases. The hospice staff will discuss these with the patient and their family. Diseases addressed by the CMS include:

AIDS

Cancer

Dementia

Stroke

Heart diseases

Heart failure

Liver diseases

Parkinson’s Disease

Multiple Sclerosis

Huntington’s Disease

Kidney failure

Lou Gehrig’s Disease (ALS)There may also be local coverage determinants, set by Medicare.

If you would like more information about qualifying for hospice and the options open to your loved one, please contact Parentis Health to learn more.