Hospice Eligibility Guidelines
By: Joseph Shega, MD, Chief Medical Officer, VITAS Healthcare
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.
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:
- Palliative Performance Scale (PPS) rating of ≤ 50%-60%
- Dependence in 3 of 6 Activities of Daily Living (ADLs)
- 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.
Disease-Specific Guidelines for Hospice Eligibility
ALSIn end-stage ALS, two factors are critical in determining prognosis: ability to breathe and ability to swallow.
Alzheimer's and DementiaWhen patients with dementia or Alzheimer’s can no longer move around, get dressed, bathe, or speak, they may be eligible for hospice care.
COPD and Lung Disease
One of the major characteristics that a COPD patient may be hospice-eligible is dyspnea at rest or with minimal exertion.
Hospice care for heart disease addresses a wide range of symptoms, including shortness of breath, chest pain, weakness, functional decline and the management of fluid status.
HIV and AIDS
Low CD4 counts, decreased performance on the KPS scale, and documentation of certain factors are all signs that your HIV/AIDS patient may be ready for hospice.
Liver disease patients may be appropriate for hospice care if they have persistent symptoms of hepatic failure, such as ascites, hepatic encephalopathy or recurrent varicella bleeding, and meet other guidelines.
In oncology, the biggest predictor of hospice eligibility is the patient’s functional status, which is determined by the Eastern Cooperative Oncology Group (ECOG) scale or the Palliative Performance Scale (PPS).
More patients and families are choosing not to start or to withdraw dialysis for multiple reasons, particularly in patients older than 60 years.
Quick, Secure and Simple
Refer your hospice-eligible patient easily. The VITAS app features:
- HIPAA-compliant hospice referrals
- Interactive scale to determine eligibility
- Disease-specific guidelines
Available for Android and iOS devices.Download now