HOSPICE ELIGIBILITY GUIDE

Who qualifies for hospice care?

Hospice eligibility is based on a patient’s medical condition, prognosis, goals of care, and applicable clinical requirements. Families do not have to wait for a crisis to ask whether hospice may be appropriate.

Medical eligibilityA serious, life-limiting illness and a qualifying prognosis are central considerations.

Goals of careHospice focuses on comfort and quality of life rather than treatment intended to cure the terminal illness.

Clinical reviewEligibility is determined through an appropriate hospice evaluation and physician certification.

THE BASIC REQUIREMENTS

Hospice eligibility is more than one symptom or diagnosis.

Under the Medicare hospice benefit, a patient is generally eligible when a hospice physician and the patient’s regular physician, if they have one, certify that the patient is terminally ill with a life expectancy of six months or less if the illness follows its usual course. The patient also chooses hospice care focused on comfort rather than treatment intended to cure the terminal illness and related conditions.

A six-month prognosis is not a six-month limit.

Patients may continue receiving hospice beyond six months when they remain eligible and are appropriately recertified.

COMMON REASONS FAMILIES ASK

Signs that it may be time to start the conversation.

No single sign proves that a person qualifies for hospice, but families often begin asking about hospice when they notice patterns such as:

Repeated hospitalizations or emergency visits
Increasing weakness, fatigue, or difficulty with daily activities
Progressive weight loss or reduced appetite
More frequent or difficult-to-control symptoms
Increasing dependence on family or professional caregivers
A serious illness that continues to progress despite treatment
A shift in priorities toward comfort, time at home, and quality of life

These changes should be reviewed in the context of the patient’s diagnosis, overall health, disease progression, and goals.

HOW AN EVALUATION WORKS

You can ask for information before making a decision.

1. Share what is happeningTell the hospice team about the diagnosis, recent changes, hospital visits, symptoms, and care needs.

2. Review clinical informationThe hospice team reviews relevant medical information and eligibility considerations.

3. Discuss goals and optionsIf hospice appears appropriate, the patient and family can decide whether the hospice approach matches their wishes.

Asking for an evaluation or information does not obligate a patient to elect hospice.

DIAGNOSES AND CONDITIONS

Hospice is not limited to one type of illness.

Hospice may be appropriate for eligible patients with cancer, heart disease, lung disease, dementia and other neurologic illnesses, kidney or liver disease, and other serious conditions. Eligibility depends on the individual clinical picture rather than the diagnosis name alone.

Eligibility is individualized.

Two people with the same diagnosis may have very different care needs and hospice eligibility.

WHEN TO CALL

Earlier questions can create more time for planning.

Families often wait until the last days of life because they think hospice is only for the final moments. In reality, eligible patients may receive hospice for months, allowing more time for symptom support, caregiver education, care planning, and family support.

Wondering if it may be time to ask about hospice?

You can call Metro Medical Hospice to talk through the situation and learn what an evaluation may involve.

☎ Call (818) 280-3249

or email us at care@metromedhospice.com