How Does Someone Qualify For Hospice?

Nov 24, 2020 | Community Education, Hospice

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Often, I am asked, “How does someone qualify for hospice?” The answer begins with an open and honest discussion about the goals of care.

In any disease trajectory, there are three possible outcomes: stability, improvement, or decline. If the likelihood of decline is high, then it is important to know what it will look like. What are the signs, symptoms, complications, and expected scenarios the patient will experience? Is that something they would like to go through? Is it something the would want to see a loved one go through?

Qualify For Hospice

How to Tell if You Qualify for Hospice

To qualify for hospice, 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 the underlying causes. Ask, “What would I like my life or my loved one’s life to look like over the next six months?” If the patient’s quality of life would not be improved by aggressive treatment such as hospitalization, surgery, chemotherapy, radiation, or hemodialysis, then they may qualify.

Nutritional Status

To determine a patient’s nutritional status, first we look for poor appetite and weight loss. Is the person eating well? Have they experienced significant weight loss over the last six months? Have they lost ten percent or more of their body weight? In a person weighing 180 pounds, for example, that would be 18 pounds lost.

Other signs of significant weight loss may include:

  • Ill-Fitting Clothes
  • Decrease in Skin Elasticity. Skin should form a “tent” when pulled lightly.
  • Increasing Skin Folds
  • Difficulty Swallowing. Usually identified as coughing when drinking and/or eating.

Functional Status

Is the patient significantly weaker than they were six months ago? Signs may include:

  • Reduced Ability to Walk
  • Unable to Work or Maintain a Job
  • Development of Pressure Sores
  • Increase Sleepiness
  • Lower Blood Pressure
  • Changes in Mental Status and Behavior

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

Qualify For Hospice

Normal Course of the Disease

Looking back over the last 6-12 months, has there been a decline in the patient’s health? If we look 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

The Centers for Medicare & Medicaid Services (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 Disease
  • Heart Failure
  • Liver Disease
  • Parkinson’s Disease
  • Multiple Sclerosis
  • Huntington’s Disease
  • Kidney Failure
  • Lou Gehrig’s Disease (ALS)

If you would like to learn more about local coverage determinants, contact the local hospice organization in your area.

Qualify For Hospice

A Final Word About Hospice

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 honest conversation between the patients, families, and healthcare providers. Only once all the factors have been considered, they will be able to make a decision that is right for them.

Do you have more questions about hospice care? Learn how Parentis provides dignity and comfort through medical, emotional and spiritual care.

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