Hospice Eligibility Guidelines

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:
  • 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.