By Joseph Shega, MD, Chief Medical Officer, VITAS Healthcare
When VITAS engages in discussions about patient eligibility for hospice care, we consciously use the phrase “hospice guidelines” rather than “hospice criteria” to ensure the incorporation of clinical judgment and better support physicians and healthcare professionals in their determination of hospice eligibility.
Why rely on “guidelines” instead of “criteria” for hospice eligibility?
In more than four decades of experience with seriously ill and advanced illness patients, our medical experts understand that no two patients are alike – meaning no single set of clinical data or specific test results can explain the variability from one patient to another, even among those who share similar clinical manifestations for the same diagnosis.
Hospice Criteria vs. Hospice Guidelines
Because VITAS understands the scope of clinical variability among patients, we embrace the use of hospice eligibility guidelines, rather than hospice criteria, as a patient-centered approach to determining who is eligible for hospice and who is not. The national hospice 2017 median length of stay at 24 days1 evidences the ineffectiveness of focusing solely on “hospice criteria.”
Focusing solely on specific data points and test results raises the possibility that physicians will overlook key clues, signs and other vulnerabilities that can impact a patient’s health. A guideline-driven approach to hospice eligibility allows physicians to see their patients as whole persons whose varying needs for care as they approach the end of life should include the option of comfort-focused hospice care as soon as they are eligible.
Hospice guidelines offer the opportunity for physicians to consider other important factors that impact the health, decline and symptoms of each individual patient.
- Does this patient have comorbidities or other symptoms/diagnoses?
- How long has this patient been ill?
- How stable is the patient’s home life and level of caregiver support?
- As symptoms and quality of life continue to decline, has the patient discussed goals of care and end-of-life preferences with family members or his/her healthcare team?
- Can a hospice referral support the patient’s goals, values and wishes?
What Are Our Hospice Guidelines?
Studies show that early, timely hospice referrals often alleviate symptoms and improve quality of life for patients and families in the time they have left. Timely hospice care also avoids unnecessary interventions near the end of life and reduces costly hospital readmissions and emergency department visits. Patients are afforded the opportunity to be comfortable at home where the majority state as their preferred location of care.
Explore our guidelines now for hospice eligibility, both to ensure that your patients are receiving hospice care as soon as they are eligible and can benefit from hospice services, and to ensure that you are providing the best possible care to your advanced illness patients.
1National Hospice and Palliative Care Organization Facts and Figures: Hospice Care in America 2017 Edition, page 4.
