Hospice Eligibility Guidelines

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Timely and appropriate identification of hospice-eligible patients increases the likelihood that they and their families will benefit from compassionate, end-of-life care. By law, healthcare professionals must certify that patients meet guidelines to be eligible for a referral to a hospice provider.

Who is Eligible for Hospice Care?

For a patient to be eligible for hospice, consider the following guidelines:

  • The illness is terminal (a prognosis of ≤ 6 months) and the patient and/or family has elected palliative care.
  • The patient has a declining functional status as determined by either:
  • The patient has alteration in nutritional status, e.g., > 10% loss of body weight over last 4-6 months
  • The patient has an observable and documented deterioration in overall clinical condition in the past 4-6 months, as manifested by at least one of the following:
    • ≥ 3 hospitalizations or ED visits
    • Decrease in tolerance to physical activity
    • Decrease in cognitive ability
  • Other comorbid conditions

These guidelines—provided as a convenient tool and not as a replacement for a physician’s professional judgment—help physicians determine when their patients meet clinical guidelines for hospice eligibility for life-limiting illnesses.

Free Download: Hospice Eligibility Checklist PDF

Disease-Specific Guidelines for Hospice Eligibility