What makes you eligible for hospice

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. These general and diagnosis-specific guidelines will help you determine if your patient is eligible for hospice. The guidelines are provided as a convenient tool and are not meant to take the place of a physician's professional judgment. Many healthcare professionals mistakenly believe that a patient must appear to be dying — critically ill, bed bound, and unable to continue living life fully — to be in hospice.

This is not true in many cases. A hospice patient may have an identified diagnosis or a group of symptoms, or a combination of both. Please see the Yolo Hospice Medicare Evaluation Tools to help you determine whether your patient meets the criteria. Our staff is always available to discuss eligibility with you.

A similar scale known as the Karnofsky scale may also be used. For cancer patients, some of the criteria used to determine whether hospice is appropriate include a decline in their condition despite therapy, metastatic cancer and a Palliative Performance Score of 70 percent or less.

Patients with some cancers, such as pancreatic and small cell lung cancer, are often eligible for hospice without the presence of other criteria. For dementia patients, it can be more difficult to determine eligibility because the disease progresses so slowly.

Although there is no set number of symptoms that a patient must experience to become eligible, hospice is generally considered when the person is also diagnosed with other conditions like pneumonia or sepsis, speaks fewer than six words per day, has trouble swallowing or frequently chokes on foods or liquids, cannot sit upright or walk without assistance or loses the ability to smile.

A spike in hospitalizations and ER visits in the past six months can be a signal that it may be time to consider hospice. This generally indicates that a disease has progressed toward its end stages and additional help is required. Consistent and progressive weight loss is another indication that hospice may be necessary.

A decline in anthropomorphic measurements may also be an indication of disease progression. Increases in somnolence, fatigue and weakness can also be considerations for hospice eligibility.