Hospice Eligibility Criteria
When is Your Patient Ready for Hospice Services?
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Patients are eligible for hospice care when a physician makes a clinical determination that life expectancy is six months or less if the terminal illness runs its normal course. To help make that determination, use these guidelines. These are provided as a convenient tool and are not meant to take the place of a physician's professional judgment.
If a patient does not meet these guidelines, they may still be eligible for hospice care due to co-morbidity or rapid decline.
General Criteria for a Hospice-Appropriate Patient
For a patient to be eligible for hospice, the following criteria must be met:
- 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
- ≥ 3 hospitalizations or ED visits
- Decrease in tolerance to physical activity
- Decrease in cognitive ability
- Other comorbid conditions
Clinical Hospice Criteria
90% of VITAS patients have a primary diagnosis of:
Other VITAS patients have diagnoses including:
All VITAS hospice patients should:
- Have a prognosis of 6 months or less if the terminal illness runs its normal course
- Agree to a care plan with goals that are palliative in
nature—the goals of care are primarily focused on
management of the patient's physical,
psychosocial, emotional and spiritual symptoms,
rather than on treatment of the primary disease
VITAS provides these guidelines as a convenient tool. They do not take the place of a physician's professional judgment.